Kadriye ONES, Göksen GÖKŞENOĞLU, Mustafa Aziz YILDIRIM

The relationship between meniscal tear and neuropathic pain in patients with knee pain

Aim: To determine whether the presence of meniscal tear, bone marrow edema, synovitis and effusions in the knee joint present a risk factor for neuropathic pain.Material and Methods: A total of 103 patients (66 females, 37 males) with knee pain were included in the study. Meniscal tear, bone marrow edema, effusion and synovitis in the knee joint were determined using magnetic resonance imaging. The neuropathic pain level of the patients were evaluated according to the Leeds Assessment of Neuropathic Symptoms & Signs (LANSS). The visual analogue scale (VAS) used for the evaluation of pain.Results: Neuropathic pain was found in 14.6% of patients according to the LANSS scale. Night pain was higher in patients with neuropathic pain compared with those without neuropathic pain (P=0.014). Rest pain was higher in patients with neuropathic pain compared with those without neuropathic pain (P=0.026).Movement pain was higher in patients with neuropathic pain compared to those without neuropathic pain (P=0.004).Meniscal tear was present in 76.7% of the patients. Neuropathic pain was identified in 16.45% of meniscal tears, and the ratios of bone marrow edema, synovitis and effusion were 22.3%, 43.7% and 64.1%, respectively. The relative risk ratios of meniscal tear, bone marrow edema, effusion in the knee and synovitis in the development of neuropathic pain (with 95% confidence interval) were 1.9 (0.4–8.1), 0.9 (0.3–2.8), 0.8 (0.3–2.2) and 0.5 (0.2–1.4), respectivelyConclusion: Based on our study findings, meniscal tears, bone marrow edema, knee effusion and synovitis lesions did not have an effect on neuropathic pain development.

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1. Fox AJ, Wanivenhaus F, Burge AJ, et al. The human meniscus: A review of anatomy, function, injury, and advances in treatment. Clin Anat 2015;28:269-87.
2. Solomon L, Warwick D, Nayagam S. Apley’s Concise System of Orthopaedics and Fractures. 3rd Edition. Great Britain: Hodder Arnold; 2005:311
3. Caterine S, Hourigan M, Getgood A. Chapter 2: The Biomechanical Function of the Menisci. In: LaPrade RF, Arendt EA, Getgood A, Faucett SC, eds. The Menisci. USA: Springer; 2017. p. 9-20.
4. Pauli C, Grogan SP, Patil S, et al. Macroscopic and histopathologic analysis of human knee menisci in aging and osteoarthritis. Osteoarthritis Cartilage 2011;19:1132-41.
5. Arendt-Nielsen L, Nie H, Laursen MB, et al. Sensitization in patients with painful knee osteoarthritis. Pain 2010;149:573-81.
6. Ashraf S, Wibberley H, Mapp PI, et al. Increased vascular penetration and nerve growth in the meniscus: a potential source of pain in osteoarthritis. Ann Rheum Dis 2011;70:523-9.
7. Wu Q, Henry JL. Changes in A beta non-nociceptive primary sensory neurons in a rat model of osteoarthritis pain. Mol Pain 2010;6:37.
8. Hochman JR, Gagliese L, Davis AM, et al. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage 2011;19:647-54.
9. Thakur M, Dickenson AH, Baron R. Osteoarthritis pain: nociceptive or neuropathic? Nat Rev Rheumatol 2014;10:374-80.
10. Dixon JS, Bird HA. Reproducibility along a 10 cm vertical visual analogue scale. Ann Rheum Dis 1981;40:87-99.
11. Yücel A, Şenocak M. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey:a validation study. Pain 2004;5:427-32.
12. Jerosch J, Prymka M, Castro WH. Proprioception of knee joints with a lesion of the medial meniscus. Acta Orthop Belg 1996;62:41-5.
13. Hirtler L, Unger J, Weninger P. Acute and chronic menisco-capsular separation in the young athlete: diagnosis, treatment and results in thirty seven consecutive patients. Int Orthop 2015;39:967-74.
14. Hochman JR, Davis AM, Elkayam J, et al. Neuropathic pain symptoms on the modified pain DETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthritis Cartilage 2013;21:1236-42.
15. Hochman JR, Gagliese L, Davis AM, et al. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage 2011;19:647-54.
16. Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle- aged and elderly persons. N Engl J Med 2008;359:1108-15.
17. Berthiaume MJ, Raynauld JP, Martel-Pelletier J, et al. Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 2005;64:556-63.
18. Ohtori S, Orita S, Yamashita M, et al. Existence of a neuropathic pain component in patients with osteoarthritis of the knee. Yonsei Med J 2012;53:801-5.
19. Golge UH, Sen HM, Kuyucu E, et al. Investigation of knee pain in osteoarthritic and neuropathic pain awareness. Acta Orthop Belg 2015;81:639-46.
20. Schaible HG. Mechanisms of chronic pain in osteoarthritis. Curr Rheumatol Rep 2012;14:549-56.
21. Roubille C, Raynauld JP, Abram F, et al. The presence of meniscal lesions is a strong predictor of neuropathic pain in symptomatic knee osteoarthritis: a cross-sectional pilot study. Arthritis Res Ther 2014;16:507.
22. Englund M, Roemer FW, Hayashi D, et al. Meniscus pathology, osteoarthritis and the treatment controversy. Nat Rev Rheumatol 2012;8:412-9.
23. Ashraf S, Wibberley H, Mapp PI, et al. Increased vascular penetration and nerve growth in the meniscus: a potential source of pain in osteoarthritis. Ann Rheum Dis 2011;70:523-9.