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Meniscal Knee Surgery May Lead to Arthritis and Cartilage Loss

By MedImaging International staff writers
Posted on 28 Dec 2014

Image: Examples of meniscal tears and status after surgery. Sagittal intermediate-weighted fat-saturated image shows a typical horizontal-oblique meniscal tear of the posterior horn reaching the undersurface of the meniscus (arrows) (Photo courtesy of RSNA).

Image: Examples of meniscal tears and status after surgery. Coronal proton density-weighted image shows another example of a tear, which represents a vertical tear of the posterior horn of the medial meniscus (arrow) (Photo courtesy of RSNA).

Image: Examples of meniscal tears and status after surgery. Sagittal intermediate-weighted fat-saturated image post-surgery shows substance loss of the posterior horn of the medial meniscus (large arrows) and concomitant cartilage (Photo courtesy of RSNA).

A widely used surgical procedure to repair meniscal tears may increase the risk of osteoarthritis and cartilage loss in some patients, according to new research. In the study, 100% of knees that had undergone surgery went on to develop arthritis, compared to 59% of those that had meniscal damage but did not have surgery.

The study’s findings were presented December 3, 2014, at the annual meeting of the Radiological Society of North America (RSNA), held in Chicago (IL, USA). The findings show that the decision for surgery requires cautious consideration to avoid faster disease onset, researchers reported. The new study centered on the meniscus, a wedge-shaped portion of the cartilage in the knee that acts as a shock absorber between the femur and tibia. The two menisci in each knee also play a significant role in joint stability. Meniscal tears are among the most common knee injuries, and surgery is frequently performed to lessen pain.

“Meniscal surgery is one of the most common orthopedic procedures performed to alleviate pain and improve joint function,” said Frank W. Roemer, MD, from the Boston University School of Medicine (Boston, MA, USA) and the University of Erlangen-Nuremberg (Erlangen, Germany). “However, increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint.”

Dr. Roemer and colleagues examined data from the Osteoarthritis Initiative, a large, ongoing observational study of knee osteoarthritis incidence and progression. Patients in the study were on average 60.2 years old and predominantly overweight, with a mean body mass index (BMI) of 28.3. Approximately two-thirds of the patients were women.

The researchers assessed magnetic resonance imaging (MRI) scans of 355 knees that developed osteoarthritis during a five-year period, and a control group that was matched for age, gender, arthritic severity in both knees and BMI. Out of all the knees, 31 underwent meniscal surgery during the year prior to the arthritis diagnosis, and 280 knees had signs of meniscal damage on MRI but did not have surgery. Additionally, part of the study included control cases with no meniscal damage. The researchers assessed the risk of developing arthritis and cartilage loss during the following year for the different groups.

“We found that patients without knee osteoarthritis who underwent meniscal surgery had a highly increased risk for developing osteoarthritis and cartilage loss in the following year compared to those that did not have surgery, regardless of presence or absence of a meniscal tear in the year before,” Dr. Roemer said.

All 31 of the knees that underwent meniscal surgery during the prior year developed osteoarthritis, compared with 165 (59%) of the knees with meniscal damage that did not have surgery. Furthermore, cartilage loss was much more common among knees that had undergone surgery: 80.8% of knees with surgery showed cartilage loss, compared with 39.5% of knees with meniscal damage and no surgery.

An alternative to surgery is conservative management. In conservative management, physical therapy is recommended to help maintain and restore muscle strength and range of motion. Symptoms are typically treated with ice and nonsteroidal anti-inflammatory drugs.

“The indications for meniscal surgery might need to be discussed more carefully in order to avoid accelerated knee joint degeneration,” Dr. Roemer concluded.

Related Links:
Boston University School of Medicine
University of Erlangen-Nuremberg

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60 (!!!!! 7809.8773956299): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

61 (275.85029602051): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (650.16746520996): SELECT fid FROM jos_deeppockets WHERE id=294756406 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294756406 AND published='1' LIMIT 1

63 (361.20414733887): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

64 (92.029571533203): select jos_twitters.link from jos_twitters where cat=10

65 (56.982040405273): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 10607.004165649): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 7021.9039916992): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 2433.0615997314): SELECT fid FROM jos_deeppockets WHERE id=294756406 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294756406 AND published='1' LIMIT 1

69 (!!!!! 2000.093460083): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (654.93583679199): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294756406 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (335.9317779541): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294756406 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 3690.0043487549): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (811.10000610352): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (!!!!! 1100.0633239746): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 1154.899597168): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (293.01643371582): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (102.99682617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (277.04238891602): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (201.94053649902): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (480.89027404785): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (501.15585327148): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (490.90385437012): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (709.05685424805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294756406 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (164.98565673828): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294756406 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (290.87066650391): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 1918.0774688721): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 1007.080078125): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (52.213668823242): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (242.94853210449): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (!!!!! 1935.0051879883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (306.84471130371): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (750.06484985352): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (!!!!! 2746.1051940918): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 1487.0166778564): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (52.213668823242): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4914.9990081787): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

105 (!!!!! 4804.8496246338): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

106 (!!!!! 1430.0346374512): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294756406 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (807.04689025879): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294756406 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2763.9865875244): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

109 (653.02848815918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

110 (684.97657775879): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294756406 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 1348.9723205566): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294756406 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1114.1300201416): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (782.96661376953): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (790.83442687988): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

115 (!!!!! 5421.1616516113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

116 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

117 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

118 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

119 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

120 (879.04930114746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

121 (120.16296386719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

122 (!!!!! 8091.926574707): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 191844.94018555): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 3730.0586700439): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294756406 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294756406 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 64997.911453247): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 2735.1379394531): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (!!!!! 3786.0870361328): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (75.817108154297): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (56.982040405273): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (381.9465637207): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (46.014785766602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (496.14906311035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (396.9669342041): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (59.127807617188): SELECT name FROM jos_deeppockets WHERE id=211

138 (43.869018554688): SELECT name FROM jos_deeppockets WHERE id=211

139 (773.90670776367): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (739.81285095215): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

142 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

143 (!!!!! 20267.963409424): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 3179.0733337402): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294756406 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (416.99409484863): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294756406 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (460.86311340332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (!!!!! 1918.0774688721): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 3742.9332733154): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

149 (363.11149597168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

150 (!!!!! 1985.0730895996): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (!!!!! 1132.9650878906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

152 (!!!!! 4044.0559387207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

153 (!!!!! 3802.0610809326): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294756406 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294756406 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 2897.9778289795): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (451.08795166016): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (!!!!! 4318.9525604248): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (685.9302520752): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

158 (930.0708770752): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294756406 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294756406 AND published='1' LIMIT 1

159 (401.97372436523): select jos_twitters.link from jos_twitters where cat=10

160 (295.16220092773): select jos_facebook.link from jos_facebook where cat=10

161 (237.94174194336): select jos_google_plus.link from jos_google_plus where cat=10

162 (422.95455932617): select jos_linkedin.link from jos_linkedin where cat=10

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