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Updated: May 8, 2026
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Knee Lyme Arthritis in Pediatric and Adolescent Patients May Be Associated With Meniscal Changes on MRI
Matthew D Milewski1,2, Kirsten Ecklund2,3, Sang Won Lee1,2
1Department of Orthopaedic Surgery-Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts.
Background:
Lyme arthritis is a common manifestation of late-stage Lyme disease in pediatric and adolescent patients. Patients with Lyme arthritis typically present with atraumatic knee effusion and may undergo magnetic resonance imaging (MRI) to aid in diagnosis. The incidence of meniscal pathology on MRI in association with Lyme arthritis is unknown. This study aims to evaluate the incidence of meniscal pathology on MRI in young patients with Lyme arthritis.
Methods:
Patients (<18 years old) presenting with a unilateral knee effusion from 2009 to 2019 with a positive Lyme antibody serologic test, MRI within 2 weeks of the positive test, and ultimate diagnosis of Lyme arthritis were included in the study. MRI, which was performed to distinguish Lyme arthritis from other causes of knee effusion, underwent analysis by a pediatric musculoskeletal radiologist. Meniscal signal abnormality was graded as follows: grade 1 = globular, grade 2 = linear nonsurfacing, and grade 3 = surfacing tear.
Results:
Eighty-seven patients (10.6 ± 3.9 years, 71.3% male, 67.8% White) were included. Fourteen (16%) patients had meniscal changes (grade 1: n = 4 [5%]; grade 2: n = 3 [3%]; grade 3: n = 7 [8%]). Thirteen of the 14 patients (93%) with meniscal changes on MRI were treated only with oral antibiotics, with resolution of knee symptoms and return to sports, whereas 1 patient (7%) underwent arthroscopic partial meniscectomy.
Conclusions:
Of the 87 pediatric patients with serologically confirmed Lyme arthritis and MRI of their affected knee, 16% had a coexistent meniscal abnormality on MRI, but only 1 patient overall required surgical treatment related to the meniscus. Physicians should be aware of potential MRI meniscal changes in pediatric and adolescent patients who present with symptomatic knee effusion because of Lyme arthritis. Future research to evaluate the physiologic effects of Lyme arthritis on meniscal tissue is needed.
Level Of Evidence:
Level IV Case Series. See Instructions for Authors for a complete description of levels of evidence.
Insights
In pediatric Lyme arthritis patients, 16% showed meniscal changes on MRI, but most recovered with antibiotics alone, indicating a need for awareness of these findings.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Musculoskeletal Radiology
Background:
- Lyme arthritis is a frequent late-stage Lyme disease manifestation in children and adolescents.
- Knee effusion is a common presentation, often requiring MRI for diagnosis.
- The occurrence of meniscal pathology in pediatric Lyme arthritis is not well-documented.
Purpose of the Study:
- To determine the incidence of meniscal pathology on MRI in pediatric and adolescent patients diagnosed with Lyme arthritis.
- To evaluate the clinical significance and treatment outcomes of meniscal abnormalities in this population.
Main Methods:
- Retrospective review of patients under 18 with unilateral knee effusion, positive Lyme serology, and MRI.
- MRI scans were analyzed by a pediatric musculoskeletal radiologist for meniscal abnormalities (graded 1-3).
- Inclusion criteria ensured diagnosis of Lyme arthritis and MRI within two weeks of positive serology.
Main Results:
- Out of 87 patients, 16% (14 patients) exhibited meniscal changes on MRI.
- The majority of patients with meniscal changes (93%) were successfully treated with oral antibiotics.
- Only one patient required surgical intervention (arthroscopic partial meniscectomy) for meniscal pathology.
Conclusions:
- A significant percentage of pediatric Lyme arthritis cases show meniscal abnormalities on MRI.
- Most meniscal changes associated with Lyme arthritis in this age group do not necessitate surgical intervention.
- Clinicians should consider potential meniscal pathology when interpreting MRIs for pediatric Lyme arthritis.
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