Meniscal Damage Predicts Likelihood of Radiographic Knee OA

BOSTON — Preventing meniscal damage should be a top therapeutic priority in the fight against knee osteoarthritis, Dr. Martin Englund said at the annual meeting of the American College of Rheumatology.

The Multicenter Osteoarthritis study (MOST) demonstrated for the first time that meniscal damage without surgical resection is a risk factor for tibiofemoral radiographic knee osteoarthritis.

The onset of knee osteoarthritis (OA) after the surgical removal of all or part of a torn meniscus is common, and numerous longitudinal studies have identified meniscectomy as a significant risk factor for knee OA, according to Dr. Englund, of Boston University, and his colleagues. However, no studies have demonstrated that meniscal damage without surgical resection is associated with the development of incident radiographic knee OA (ROA), he said. To evaluate the effect of baseline meniscal damage on incident tibiofemoral radiographic OA, the researchers conducted a nested case-control investigation comprising patients enrolled in the MOST study, a prospective observational study of 3,026 individuals older than age 50 who have or are at high risk for knee OA. Prior knee surgery patients were excluded. Participants had standardized, weight-bearing fixed-flexion x-rays at baseline and at 30 months.

These x-rays were read paired by a musculoskeletal radiologist and rheumatologist, both blinded to clinical and MRI data, Dr. Englund explained.

For the current study, 52 knees with no tibiofemoral ROA at baseline but evidence of grade 2 or higher ROA on the Kellgren-Lawrence scale in the 30-month follow-up were cases; 130 knees drawn from the same source population but with no tibiofemoral ROA at follow-up were controls.

To assess the baseline meniscal status of the knees, two blinded musculoskeletal radiologists reviewed coronal and sagittal fast spin echo MRI images and evaluated each on a collapsed scale. Knees with no damage were grade 0, those with a minor tear were grade 1, and those with a nondisplaced tear, displaced tear, maceration, or destruction were considered grade 2.

The investigators analyzed the link between meniscal damage and ROA using two logistic regression models (one in which the meniscal score was entered as 0, 1, or 2, and one in which it was entered as meniscal damage or no damage) adjusted for age, sex, body mass index, physical activity, and mechanical knee alignment.

“Meniscal damage at baseline was significantly more common in cases than in controls,” Dr. Englund reported, evident in 52% of case knees, versus 18% of controls.

In a multivariable model, the odds ratio of incident tibiofemoral ROA increased as the meniscal score increased, Dr. Englund noted. When knees with meniscal damage were compared with knees that had a normal meniscus at baseline, the adjusted odds ratio for ROA at 30 months was 4.3 for knees with a meniscal score of 1 and 7.8 for those with a meniscal score of 2.

Dr. Englund disclosed no financial conflicts related to his presentation.

Meniscal damage at baseline was 52% more common in case knees versus 18% of controls. DR. ENGLUND

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BOSTON — Preventing meniscal damage should be a top therapeutic priority in the fight against knee osteoarthritis, Dr. Martin Englund said at the annual meeting of the American College of Rheumatology.

The Multicenter Osteoarthritis study (MOST) demonstrated for the first time that meniscal damage without surgical resection is a risk factor for tibiofemoral radiographic knee osteoarthritis.

The onset of knee osteoarthritis (OA) after the surgical removal of all or part of a torn meniscus is common, and numerous longitudinal studies have identified meniscectomy as a significant risk factor for knee OA, according to Dr. Englund, of Boston University, and his colleagues. However, no studies have demonstrated that meniscal damage without surgical resection is associated with the development of incident radiographic knee OA (ROA), he said. To evaluate the effect of baseline meniscal damage on incident tibiofemoral radiographic OA, the researchers conducted a nested case-control investigation comprising patients enrolled in the MOST study, a prospective observational study of 3,026 individuals older than age 50 who have or are at high risk for knee OA. Prior knee surgery patients were excluded. Participants had standardized, weight-bearing fixed-flexion x-rays at baseline and at 30 months.

These x-rays were read paired by a musculoskeletal radiologist and rheumatologist, both blinded to clinical and MRI data, Dr. Englund explained.

For the current study, 52 knees with no tibiofemoral ROA at baseline but evidence of grade 2 or higher ROA on the Kellgren-Lawrence scale in the 30-month follow-up were cases; 130 knees drawn from the same source population but with no tibiofemoral ROA at follow-up were controls.

To assess the baseline meniscal status of the knees, two blinded musculoskeletal radiologists reviewed coronal and sagittal fast spin echo MRI images and evaluated each on a collapsed scale. Knees with no damage were grade 0, those with a minor tear were grade 1, and those with a nondisplaced tear, displaced tear, maceration, or destruction were considered grade 2.

The investigators analyzed the link between meniscal damage and ROA using two logistic regression models (one in which the meniscal score was entered as 0, 1, or 2, and one in which it was entered as meniscal damage or no damage) adjusted for age, sex, body mass index, physical activity, and mechanical knee alignment.

“Meniscal damage at baseline was significantly more common in cases than in controls,” Dr. Englund reported, evident in 52% of case knees, versus 18% of controls.

In a multivariable model, the odds ratio of incident tibiofemoral ROA increased as the meniscal score increased, Dr. Englund noted. When knees with meniscal damage were compared with knees that had a normal meniscus at baseline, the adjusted odds ratio for ROA at 30 months was 4.3 for knees with a meniscal score of 1 and 7.8 for those with a meniscal score of 2.

Dr. Englund disclosed no financial conflicts related to his presentation.

Meniscal damage at baseline was 52% more common in case knees versus 18% of controls. DR. ENGLUND

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — Preventing meniscal damage should be a top therapeutic priority in the fight against knee osteoarthritis, Dr. Martin Englund said at the annual meeting of the American College of Rheumatology.

The Multicenter Osteoarthritis study (MOST) demonstrated for the first time that meniscal damage without surgical resection is a risk factor for tibiofemoral radiographic knee osteoarthritis.

The onset of knee osteoarthritis (OA) after the surgical removal of all or part of a torn meniscus is common, and numerous longitudinal studies have identified meniscectomy as a significant risk factor for knee OA, according to Dr. Englund, of Boston University, and his colleagues. However, no studies have demonstrated that meniscal damage without surgical resection is associated with the development of incident radiographic knee OA (ROA), he said. To evaluate the effect of baseline meniscal damage on incident tibiofemoral radiographic OA, the researchers conducted a nested case-control investigation comprising patients enrolled in the MOST study, a prospective observational study of 3,026 individuals older than age 50 who have or are at high risk for knee OA. Prior knee surgery patients were excluded. Participants had standardized, weight-bearing fixed-flexion x-rays at baseline and at 30 months.

These x-rays were read paired by a musculoskeletal radiologist and rheumatologist, both blinded to clinical and MRI data, Dr. Englund explained.

For the current study, 52 knees with no tibiofemoral ROA at baseline but evidence of grade 2 or higher ROA on the Kellgren-Lawrence scale in the 30-month follow-up were cases; 130 knees drawn from the same source population but with no tibiofemoral ROA at follow-up were controls.

To assess the baseline meniscal status of the knees, two blinded musculoskeletal radiologists reviewed coronal and sagittal fast spin echo MRI images and evaluated each on a collapsed scale. Knees with no damage were grade 0, those with a minor tear were grade 1, and those with a nondisplaced tear, displaced tear, maceration, or destruction were considered grade 2.

The investigators analyzed the link between meniscal damage and ROA using two logistic regression models (one in which the meniscal score was entered as 0, 1, or 2, and one in which it was entered as meniscal damage or no damage) adjusted for age, sex, body mass index, physical activity, and mechanical knee alignment.

“Meniscal damage at baseline was significantly more common in cases than in controls,” Dr. Englund reported, evident in 52% of case knees, versus 18% of controls.

In a multivariable model, the odds ratio of incident tibiofemoral ROA increased as the meniscal score increased, Dr. Englund noted. When knees with meniscal damage were compared with knees that had a normal meniscus at baseline, the adjusted odds ratio for ROA at 30 months was 4.3 for knees with a meniscal score of 1 and 7.8 for those with a meniscal score of 2.

Dr. Englund disclosed no financial conflicts related to his presentation.

Meniscal damage at baseline was 52% more common in case knees versus 18% of controls. DR. ENGLUND

ELSEVIER GLOBAL MEDICAL NEWS