Meniscal Pathology
Characterizing Knee Menisci Pathology for Optimal Diagnosis and Treatment of Meniscal Disorders
Brandon Roller, PI; Jimi Cook, Co-PI
Nearly one million operative procedures are performed each year in the US to address problems related to knee menisci. The majority of these surgeries result in resection of a portion of the menisci resulting in deficient meniscal function within the knee joint. Menisci must be maintained in their normal size, shape, and composition in order to perform their necessary functions in the knee including stability, congruity, load distribution, shock absorption, lubrication, and joint nutrition. Deficiencies in one or more of these components of the meniscus result in dysfunction and associated signs and symptoms such as pain, effusion, crepitus, and mechanical impingement. Loss of meniscal integrity also causes a lack of articular cartilage protection, which inevitably will lead to osteoarthritis and disability in affected individuals. Therefore, the development of optimal treatment strategies that preserve, replace, or induce regeneration of missing meniscal tissue are of paramount importance for clinicians faced with the problem of the meniscal deficient knee.
Much more progress is needed before the common problem of the meniscal deficient knee can be comprehensively treated. The major impediments to addressing this problem are the lack of understanding of pathology of the tissue, the inability to diagnose meniscal pathology prior to clinical disease, and the deficiencies present in fully assessing various treatment options with respect to long-term effects on knee joint and limb function. Although the knee meniscus has been studied for years, relatively little data are available regarding comprehensive meniscal characterization. It is important to determine the changes that occur from a normal meniscus – to a meniscus that has an avascular lesion or vascular lesion, to one associated with degenerative joint disease and osteoarthritis. Understanding these basic science components of meniscal disorders should provide an avenue for determining etiopathogenesis, evaluating the possible treatment options present, and determining patient prognosis. In order to address this goal, the following specific aims were developed: Specific Aim 1: Characterize and correlate the molecular and biochemical markers of meniscal disease to histologic, imaging, and gross indicators of meniscal pathology in the human knee, and Specific Aim 2: Delineate which indicators of meniscal pathology are most useful for optimizing diagnostic, therapeutic, and prognostic strategies. Our hypothesis is that patients with meniscal disease will have significant differences in molecular and protein markers of extracellular matrix synthesis and degradation, inflammation, and signaling when compared to controls (age-matched and “normal”). We believe that these markers will correlate to histologic, imaging, and gross measures of meniscal pathology, thereby serving as definitive indicators of disease presence and severity.
Overall, these data will help determine which basic science measures of pathology best correlate to, and hence predict, clinical disease in terms of extent and severity. In addition, the data will be examined to determine which factors, basic science and clinical, may influence extent and severity of disease, and/or outcome. The subsequent research that these data can spawn is nearly limitless; however, without initial comprehensive characterization and correlation of multiple measures of pathology, the foundation for prospective study is lost. We believe that advancement of this project will provide a strong scientific basis to assist in diagnosis, treatment options, and improvement in determining prognosis in relation to meniscal pathology, a common injury faced by many individuals.