Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis

Adams, J; McAlindon, T.E.; DiMasi, Matthew; Carey, John J.; Eustace, Stephen

doi:10.1016/s0009-9260(99)90846-2

Cited by 275 publications

(206 citation statements)

References 12 publications

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“…When we examined the baseline cartilage scores for these "false-positive" radiographic progressor knees, they tended to be worse than in those who had neither MRI nor radiographic changes (data not shown). The radiographic progression of joint space narrowing in these individuals may have represented meniscal extrusion (2). Further study on the contribution of both meniscal disease and cartilage loss to changes in radiographic joint space width is needed, and will be the topic of another report.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the distance between the femur and tibia represents more than just hyaline articular cartilage, since the meniscus is lying in the same space. Therefore, in some instances progression of joint space narrowing could reflect meniscal extrusion rather than true cartilage loss (2). Since strategies that optimize reproducibility and accuracy of knee radiographic joint space measurement focus on the medial compartment (3), the ability of radiography to evaluate changes in the lateral compartment of the knee may be more limited.…”

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confidence: 99%

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The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis

Amin¹,

LaValley²,

Guermazi³

et al. 2005

Arthritis & Rheumatism

202

160

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Objective. To determine the relationship between radiographic progression of joint space narrowing and cartilage loss on magnetic resonance imaging (MRI) in patients with symptomatic knee osteoarthritis (OA), and to investigate the location of MRI-based cartilage loss in the knee and its relation to radiographic progression.Methods. Two hundred twenty-four men and women (mean age 66 years) were studied. Radiographs and MRI of the more symptomatic knee were obtained at baseline and at 15-and 30-month followup. Radiographs of the knee (with weight-bearing) were read for joint space narrowing (scale 0-3), with progression defined as any worsening in score. We used a semiquantitative method to score cartilage morphology in all 5 regions of the tibiofemoral joint, and defined cartilage loss as an increase in score (scale 0-4) at any region. We examined the relationship between progression of joint space narrowing on radiographic images and cartilage loss on MRI, using a generalized estimating equation proportional odds logistic regression, adjusted for baseline cartilage score, age, body mass index, and sex. The medial and lateral compartments were analyzed separately.Results. In the medial compartment, 104 knees (46%) had cartilage loss detected by MRI. The adjusted odds ratio was 3.7 (95% confidence interval 2.2-6.3) for radiographic progression being predictive of cartilage loss on MRI. However, there was still a substantial proportion of knees (80 of 189 [42%]) with cartilage loss visible on MRI when no radiographic progression was apparent. Cartilage loss occurred frequently in the central regions of the femur and tibia as well as the posterior femur region, but radiographic progression was less likely to be observed when posterior femur regions showed cartilage loss. Radiographic progression appeared specific (91%) but not sensitive (23%) for cartilage loss. Overall findings were similar for the lateral compartment.Conclusion. While our results provide longitudinal evidence that radiographic progression of joint space narrowing is predictive of cartilage loss assessed on MRI, radiography is not a sensitive measure, and if used alone, will miss a substantial proportion of knees with cartilage loss.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis

Amin¹,

LaValley²,

Guermazi³

et al. 2005

Arthritis & Rheumatism

202

160

View full text Add to dashboard Cite

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“…This finding was verified in the present study. The presence of JSN on conventional radiographs with a semiflexed knee might reflect the loss and (or) subluxation of meniscal tissue, not only loss of joint cartilage (35). However, meniscal extrusion is associated with OA of the knee (22,36).…”

Section: Discussionmentioning

confidence: 99%

Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: A sixteen‐year followup of meniscectomy with matched controls

Englund¹,

Roos²,

Lohmander³

2003

Arthritis & Rheumatism

541

515

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Objective. To investigate long-term radiographic and patient-relevant outcome of isolated limited meniscectomy with regard to type of meniscal tear and extent of surgical resection.Methods. We studied 155 patients with intact cruciate ligaments (mean ؎ SD age 54 ؎ 12 years) who had undergone meniscectomy an average of 16 ؎ 1 years earlier. The patients were examined using standardized radiography and validated self-administered questionnaires. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to quantify knee-related symptoms, and the definition of a symptomatic knee was determined. We used 68 control subjects matched for age, sex, and body mass index to calculate the relative risks (RRs).Results. Radiographic tibiofemoral osteoarthritis (OA) (Kellgren/Lawrence grade >2) was present in 66 index knees (43%), of which 39 (59%) were considered to be symptomatic according to the KOOS. In total, 77 patients (50%) had a symptomatic index knee. In a multivariate model, degenerative meniscal tears were associated with both radiographic OA (P ‫؍‬ 0.030) and combined radiographic and symptomatic OA (P < 0.015). The RRs for combined radiographic and symptomatic OA after degenerative and traumatic types of meniscal tear were 7.0 (95% confidence interval [95% CI] 2.1-23.5) and 2.7 (95% CI 0.9-7.7), respectively, compared with matched controls.Conclusion. An isolated meniscal tear treated by limited meniscectomy is associated with a high risk of radiographic and symptomatic tibiofemoral OA at 16-year followup. Factors associated with worse outcome were degenerative meniscal lesions and extensive resections. We suggest that degenerative meniscal tears may be associated with incipient OA, and that the meniscal tear signals the first symptom of the disease.

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“…Conventional radiographs are an unreliable method of evaluating articular cartilage loss in patients with early OA, as initial JSN is secondary to meniscal pathologies rather than thinning of articular cartilage in most cases (21). Joint space is shared by both articular cartilage and meniscus.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Changes in Global Knee Structures Assessed by Magnetic Resonance Imaging and Radiographic Osteoarthritis Changes Over Ten Years in a Midlife Cohort

Khan

Chou

Aitken

et al. 2016

Arthritis Care & Research

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Objective. The aim of this study was to describe the correlation between changes in structural abnormalities assessed on magnetic resonance imaging (MRI) and change in radiographic osteoarthritis (OA) over 10 years in a midlife cohort. Methods. A total of 211 participants (mean age 45 years [range 26-61 years], 57% female) were studied at baseline, 2 years, and 10 years. Approximately one-half were adult offspring of subjects who had undergone knee replacement for OA and the remainders were randomly selected controls. Joint space narrowing (JSN) and osteophytes were assessed from radiographs, while cartilage volume, cartilage defects, and meniscal tears/extrusion were assessed from MRI. Spearman ranked correlation analysis was used to describe the correlation between structural changes assessed on MRI and radiographs. Only medial tibiofemoral compartment results are presented, as the lateral compartment had limited change. Results. Over 10 years, change in meniscal tears showed a moderate independent correlation with change in both JSN (r 5 10.37, P < 0.01) and osteophytes (r 5 10.31, P < 0.01) in the adjusted analysis. Meniscal extrusion (r 5 10.22, P < 0.01) and cartilage defects (r 5 10.16, P < 0.04) showed a slightly weaker independent correlation with JSN in the adjusted analysis, whereas cartilage volume loss showed no significant correlation with either of the 2 radiographic outcomes. Conclusion. Change in JSN is correlated with change in meniscal tears and, to a lesser extent, with meniscal extrusion and cartilage defects. In this sample, change in JSN is a composite measure that does not reflect cartilage volume loss, prompting the review of the use of JSN as an outcome measure in chondro-protective drug trials.

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Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis

Cited by 275 publications

References 12 publications

The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis

The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis

Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: A sixteen‐year followup of meniscectomy with matched controls

Correlation Between Changes in Global Knee Structures Assessed by Magnetic Resonance Imaging and Radiographic Osteoarthritis Changes Over Ten Years in a Midlife Cohort

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