Grinding/Clicking Knees Versus Catching/Locking Knees

A Brigham and Women’s Hospital research team took a hard look at knee arthroscopy as a treatment for some of the most common patient-reported problems—grinding, clicking, catching, locking, and painful knees which are, ultimately, diagnosed as degenerative meniscal tears. Their work, “Grinding, Clicking, and Pivot Pain Resolve in Most Patients After Knee Arthroscopy,” was published in the July 12, 2022, edition of Arthroscopy.

Elizabeth Matzkin, M.D., chief of Women’s Sports Medicine at Brigham and Women’s Hospital, associate professor at Harvard Medical School and co-author, explained the purpose and genesis of the study to  OTW. “Knee arthroscopy is a commonly performed surgery to treat both symptomatic meniscal tears and a constellation of knee symptoms related to cartilage disease and early osteoarthritis.”

“Our recent prospective study evaluating the etiology of these patient reported knee symptoms found that they are driven primarily by both the severity and number of compartments with focal cartilage lesions rather than meniscal tear.”

“To evaluate the therapeutic benefit of knee arthroscopy in response to the aforementioned study, in this current study we looked to evaluate resolution of knee symptoms following knee arthroscopy, clinical and demographic factors that predict symptom persistence, and overall patient-reported outcomes using the Knee Injury and Osteoarthritis Outcome Score questionnaire.”

Using data from 584 patients who underwent knee arthroscopy from August 2012 to December 2019 (one surgeon), the researchers assessed information on frequency of knee grinding/clicking, catching/locking, and/or pivot pain preoperatively and one and two years postoperatively.

“Postoperative knee symptom resolution was more likely for the grinding/clicking and pivot pain symptom domains than for the catching/locking symptom domain at all postoperative timepoints,” explained Dr. Matzkin to OTW.

“Clinical and demographic factors, including smoking status, overweight/obesity, absence of meniscal tear, and increased number of compartments with focal chondral lesions predicted persistence of patient reported knee symptoms. Lastly, Knee Injury and Osteoarthritis Outcome Score subscales consistently improved postoperatively, with a twofold improvement in Knee Injury and Osteoarthritis Outcome Score subscales for those whose symptoms resolved compared to those with persistent symptoms.”

“The results of the current study demonstrate utility in knee arthroscopy for patients with preoperative ‘meniscal’ and ‘mechanical’ knee with four out of five patients having clinically significant improvement (Minimal Clinically Important Differences >8) for Knee Injury and Osteoarthritis Outcome Score pain activities of daily living and quality of life.”

“This study supports symptom improvement after knee arthroscopy for patients with meniscal tears and focal cartilage lesions resulting in grinding and clicking. Patients with catching, locking and pivot pain may experience persistence of symptoms which was also noted in smokers, overweight patients, and more compartments with focal cartilage lesions.”