Meniscal extrusion and bone marrow lesions are associated with incident and progressive knee osteoarthritis

Teichtahl, Andrew; Cicuttini, Flavia Maria; Abram, F.; Wang, Yuanyuan; Pelletier, Jean‐Pierre; Dodin, Pierre; Martel‐Pelletier, Johanne

doi:10.1016/j.joca.2017.02.792

Cited by 63 publications

(61 citation statements)

References 31 publications

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“…ME is a risk factor for cartilage loss and knee osteoarthritis. [15][16][17] For this reason, it is a challenge for surgeons to prevent or diminish graft or implant extrusion in patients undergoing meniscal substitutions. Different methods have been described to prevent extrusion in MAT.…”

Section: Discussionmentioning

confidence: 99%

Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function?

et al. 2020

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Meniscal extrusion (ME) has been identified as a risk factor in the development of knee osteoarthritis. The relevance of this finding when a meniscal scaffold is used has not been extensively studied. The objective of this study was to determine whether preoperative meniscal remnant extrusion (MRE) was correlated with postoperative scaffold extrusion (SE) or with functional outcomes at the 2-year follow-up. Retrospective study included all polyurethane scaffolds implanted with a minimum 2-year follow-up. A magnetic resonance imaging (MRI) was performed preoperatively and postoperatively at 2 years. Extrusion was measured in millimeters in a coronal view. Patients were assigned to either group 1 or 2 depending on the preoperative MRE being either <3 mm (minor extrusion) or 3 mm (major extrusion). Functional outcomes were analyzed by means of the Western Ontario Meniscal Evaluation Tool (WOMET), International Knee Documentation Committee, Kujala and Tegner scores, as well as visual analog scale. Satisfaction was also documented. Sixty-two out of 98 patients were available to undergo an MRI at final follow-up. The mean age was 41.3 years (range, 17–58) and the mean follow-up was 45 months (range, 25–69). The mean preoperative MRE was 2.8 mm (standard deviation [SD] 1.2) and the mean postoperative SE was 3.8 mm (SD 1.8) (p < 0.01). All functional scores improved during the study period. When the correlation (Spearman's rho) between the difference in extrusion between the pre 26 and postoperative periods and their correlation with the different scores was assessed, correlation was only observed in the WOMET (rho 0.61, p = 0.02). The preoperative MRE in Group 1 was 1.85 mm (SD 0.83) and 3.7 mm (SD 2.2) in Group 2 (p < 0.01). At final follow-up, SE was 3.86 mm (SD 0.7) in Group 1, whereas it was 3.98 mm (SD 1) in Group 2 (p = 0.81). No differences were observed in the scores used for these two groups. The SE observed at the 2-year follow-up after the implantation of a polyurethane scaffold did not depend on preoperative MRE (major or minor extrusion). The WOMET score, which was the only meniscal-specific functional scored used, showed some inferior results in the most extruded meniscal scaffolds. This is a retrospective case series. Level of evidence is 4.

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Section: Discussionmentioning

confidence: 99%

Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function?

et al. 2020

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“…TKA, total knee arthroplasty [Color figure can be viewed at wileyonlinelibrary.com] significant baseline radiographic OA. Conversely, in the setting of existing OA, Raynauld et al 12 and Teichtahl et al 13 found medial extrusion rather than lateral extrusion to be a predictor of TKA. In the nonarthritic knee, prior biomechanical studies have demonstrated that due to increased asymmetry of lateral compartment cartilage surfaces, the lateral meniscus bears a greater percentage of lateral compartment loads (approximately 70%) than the medial meniscus bears for the medial compartment (approximately 50%).…”

Section: Independent Association Between Meniscal Status and Risk Omentioning

confidence: 97%

“…10,11 Meniscal extrusion, which is often but not always secondary to a meniscal tear, has also been associated with increased cartilage volume loss in the setting of existing OA, 11,12 as well as with middle-aged adults without radiographic OA. 13 Meniscal root tears cause a disruption of hoop forces and an increase in tibiofemoral contact pressures equivalent to that of a total meniscectomy. 3,7,8 Root tears can be difficult to diagnose on magnetic resonance imaging (MRI), 10,14 though meniscal extrusion may be a useful indirect indication of a root tear as over 50% of patients with evidence of a medial meniscus extrusion on imaging also had a medial meniscus root tear.…”

mentioning

confidence: 99%

Meniscus tears accelerate joint space loss and lateral meniscal extrusion increases risk of knee arthroplasty in middle‐aged adults

Everhart

Magnussen

Abouljoud

et al. 2020

Journal Orthopaedic Research

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We sought to use publicly available data from the Osteoarthritis Initiative (OAI), a multicenter prospective cohort study, to determine the rate of joint space loss and likelihood of knee arthroplasty due to magnetic resonance imaging (MRI)-diagnosed meniscal tears or meniscal extrusion in middle-aged adults with no to mild knee osteoarthritis. Participants (n = 2199; mean age, 60.2 years) with Kellgren-Lawrence osteoarthritis grades 2 (mild) (48.7%) or 0 to 1 (none) (51.3%) underwent knee MRIs at enrollment and were followed radiographically for 8 years and for total knee arthroplasty (TKA) for 9 years. Rate of joint space loss and risk of arthroplasty due to meniscal tears and/or extrusion were determined by multivariate modeling. Prevalence of baseline medial meniscus tears was 21.3% and lateral tears was 12.8%; 26.9% had medial meniscal extrusion (79.6%, <2 mm; 20.4%, +2 mm) and 5.4% had lateral extrusion (75.9%, <2 mm; 24.1%, +2 mm). Median medial joint space loss was 0.06 mm/y and lateral was 0.05 mm/y. Medial tears regardless of extrusion were associated with accelerated medial joint space loss (additional mean, 0.05 mm/y; P = .001). Lateral tears were associated with accelerated lateral joint space loss (additional 0.09 mm/y; P < .001) as was lateral extrusion (additional 0.10 mm/y; P < .001). The yearly incidence of knee arthroplasty was 0.5% without lateral extrusion, 1.5% with extrusion less than 2.0 mm, and 3.7% with extrusion greater than or equal to 2.0 mm. Both medial and lateral tears accelerate joint space loss in middle-aged adults. Lateral meniscal extrusion further accelerates joint space loss and increases risk of progression to TKA within 9 years. K E Y W O R D S knee osteoarthritis, meniscal extrusion, meniscus tears, total knee arthroplasty 1 | INTRODUCTION An intact knee meniscus plays a critical role and serves to preserve normal joint surface contact forces by providing load dispersion and withstanding shear and compression forces. 1,2 Meniscal tears are one of the most commonly encountered orthopedic injuries, with an incidence of 24 per 100 000 person-years. 3 There has been increasing evidence that damage to the meniscus and removal of meniscal tissue via meniscectomy can result in early-onset osteoarthritis (OA) later in life. 4,5 Meniscus loss can result in increased joint laxity,

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“…For example, clinical follow‐up studies have demonstrated that partial lateral meniscectomy, particularly in patients with posterior root partial meniscectomies, are at higher risk for the development of OA than are medial PM patients . Bone marrow lesions (BMLs) have been reported in association with meniscus pathology, providing further evidence of the important role of the meniscus in joint contact mechanics, and such BMLs have also been associated with cartilage degeneration and OA progression, particularly in cases with meniscal extrusion or axial malalignment …”

Section: Mechanical Predictors Of the Response To Partial Meniscectomymentioning

confidence: 99%

Biological and Mechanical Predictors of Meniscus Function: Basic Science to Clinical Translation

Rodeo

Monibi

Dehghani

et al. 2019

Journal Orthopaedic Research

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Progressive knee joint degeneration occurs following removal of a torn meniscus. However, there is significant variability in the rate of development of post-meniscectomy osteoarthritis (OA). While there is no current consensus on the risk factors for development of knee OA in patients with meniscus tears, it is likely that both biological and biomechanical factors play critical roles. In this perspective paper, we review the mechanical and the biological predictors of the response of the knee to partial meniscectomy. We review the role of patient-based studies, in vivo animal models, cadaveric models, bioreactor systems, and statistically augmented computational models for the study of meniscus function and post-meniscectomy OA, providing insight into the important interplay between biomechanical and biologic factors. We then discuss the clinical translation of these concepts for "biologic augmentation" of meniscus healing and meniscus replacement. Ultimately, collaborative studies between engineers, biologists, and clinicians is the optimal way to improve our understanding of meniscus pathology and response to injury and/or disease, and to facilitate effective translation of laboratory findings to improved treatments for our patients.

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Meniscal extrusion and bone marrow lesions are associated with incident and progressive knee osteoarthritis

Abstract: The presence of baseline meniscal extrusion and BMLs are associated with incident and progressive knee of each other (OA) and represent important structural targets for the treatment and prevention of knee OA.

Cited by 63 publications

References 31 publications

Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function?

Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function?

Meniscus tears accelerate joint space loss and lateral meniscal extrusion increases risk of knee arthroplasty in middle‐aged adults

Biological and Mechanical Predictors of Meniscus Function: Basic Science to Clinical Translation

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