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

Everhart, Joshua S.; Magnussen, Robert A.; Abouljoud, Moneer M.; Regalado, Luis E.; Kaeding, Christopher C.; Flanigan, David C.

doi:10.1002/jor.24672

Cited by 9 publications

(7 citation statements)

References 46 publications

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“…Recently, some studies reported an association between lateral meniscal extrusion and knee OA. 14,31 Although DLM-reshaping surgery has shown good clinical outcomes in many previous studies, 40% to 50% of patients reported postoperative OA progression. 2,10 However, a few studies have investigated the relationship between DLM extrusion and knee articular cartilage degeneration.…”

Section: Discussionmentioning

confidence: 98%

“…Medial meniscal extrusion progresses, resulting in knee OA changes 8,45,46,49 related to osteonecrosis. 14,39 Biomechanical in vivo studies have demonstrated that meniscal extrusion caused by a posterior root or radial tear results in a decreased tibiofemoral contact area and consequently increases the tibiofemoral contact pressure. 15,29,34 A medial meniscal extrusion of ≥3 mm was suggested to be pathological, 12,17,41 and this measurement is probably the most widely acknowledged cutoff value for research purposes.…”

Section: Discussionmentioning

confidence: 99%

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Association of Postoperative Lateral Meniscal Extrusion With Cartilage Degeneration on Magnetic Resonance Imaging After Discoid Lateral Meniscus Reshaping Surgery

Nishino

Hashimoto

Iida

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Although arthroscopic reshaping surgery for a discoid lateral meniscus (DLM) has good clinical results, it cannot completely prevent degeneration. The degree of DLM extrusion associated with degenerative changes is unclear. Purpose/Hypothesis: To measure meniscal extrusion preoperatively and postoperatively in patients who underwent DLM-reshaping surgery and examine factors associated with knee articular cartilage degeneration. It was hypothesized that meniscal extrusion existed preoperatively, progressed postoperatively, and was related to knee joint degeneration. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed the medical records of patients who underwent DLM-reshaping surgery and attended ≥2 years of follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 24 months postoperatively, and residual midbody meniscal extrusion was measured. Cartilage degeneration was detected when the Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the lateral compartment was grade ≥3 at 2 years postoperatively. Factors associated with MRI cartilage degeneration were evaluated. Results: Included in this study were 48 knees in 39 patients; the mean patient age at the time of surgery was 12.0 years. The mean midbody meniscal extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 24 months postoperatively ( P < .001). According to the WORMS cartilage score, 16 patients were categorized as having MRI cartilage degeneration. Multivariate logistic analysis showed that an inferior preoperative Lysholm score (odds ratio, 0.89; P = .024) and postoperative extrusion (odds ratio, 6.18; P = .010) significantly increased the risk of cartilage degeneration. The receiver operating characteristic curve showed that a residual meniscal extrusion of 2.0 mm was the cutoff value indicating cartilage degeneration (sensitivity, 87.5%; specificity, 78.1%). Conclusion: DLM extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 2 years postoperatively. Postoperative extrusion and a lower preoperative Lysholm score were factors related to MRI cartilage degeneration postoperatively. A postoperative extrusion of 2.0 mm was the cutoff value for MRI cartilage degeneration.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Association of Postoperative Lateral Meniscal Extrusion With Cartilage Degeneration on Magnetic Resonance Imaging After Discoid Lateral Meniscus Reshaping Surgery

Nishino

Hashimoto

Iida

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Results from the several studies which have examined the association between quadriceps torque and radiographic TFJ structure following ACLR have been mixed [22,35]. As these studies used radiographs to measure TFJ structure, direct assessment of articular cartilage morphology was not possible and TFJ space narrowing measured by radiographs as reported by Tourville et al [35] is often secondary to meniscal extrusion rather than indicative of thinning of the articular cartilage [6]. The present study extended analysis of quadriceps strength to include functionally relevant, angle-speciic torque measurements and found that knee extension torque between 60° and 40° knee lexion explained 57-61% (inal covariate-adjusted models) of the variance in medial tibial cartilage volume.…”

Section: Discussionmentioning

confidence: 99%

Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume

Hipsley

Hall

Saxby

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeQuadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross‐sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2 years following ACLR and determine the influence of concomitant meniscal pathology. MethodsThe involved limb of 51 ACLR participants (31 isolated ACLR; 20 combined meniscal pathology) aged 18–40 years were tested at 2.4 ± 0.4 years post‐surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°–50°, 50°–40°, 40°–30°, 30°–20°, 20°–10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle‐specific knee extension torque and MRI‐derived cartilage volumes were evaluated using multiple linear regression. ResultsIn ACLR participants with and without meniscal pathology, higher knee extension torques at 60°–50° and 50°–40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle‐specific knee extension torques and patellar cartilage volume. ConclusionHigher quadriceps strength at knee flexion angles of 60°–40° was associated with lower cartilage volume on the medial tibia ~ 2 years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes. Level of evidenceIII.

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“…Both ACL injury and meniscal lesions are known to increase the risk of osteoarthritis and subsequent TKA 8,[36][37][38][39][40] . In the present cartilage cohort, neither meniscal resection nor ACL surgery was associated with an increased risk of knee arthroplasty.…”

Section: Risk Of Arthroplastymentioning

confidence: 99%

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

Birkenes

Furnes

Lygre

et al. 2023

Journal of Bone and Joint Surgery

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Background:Focal cartilage lesions are common in the knee. The risk of later ipsilateral knee arthroplasty remains unknown. The purposes of the present study were to evaluate the long-term cumulative risk of knee arthroplasty after arthroscopic identification of focal cartilage lesions in the knee, to investigate the risk factors for subsequent knee arthroplasty, and to estimate the subsequent cumulative risk of knee arthroplasty compared with that in the general population.Methods:Patients who had undergone surgical treatment of focal cartilage lesions at 6 major Norwegian hospitals between 1999 and 2012 were identified. The inclusion criteria were an arthroscopically classified focal cartilage lesion in the knee, an age of ≥18 years at the time of surgery, and available preoperative patient-reported outcomes (PROMs). The exclusion criteria were osteoarthritis or “kissing lesions” at the time of surgery. Demographic data, later knee surgery, and PROMs were collected with use of a questionnaire. A Cox regression model was used to adjust for and investigate the impact of risk factors, and Kaplan-Meier analysis was performed to estimate cumulative risk. The risk of knee arthroplasty in the present cohort was compared with that in the age-matched general Norwegian population.Results:Of the 516 patients who were eligible, 322 patients (328 knees) consented to participate. The mean age at the time of the index procedure was 36.8 years, and the mean duration of follow-up was 19.8 years. The 20-year cumulative risk of knee arthroplasty in the cartilage cohort was 19.1% (95% CI, 14.6% to 23.6%). Variables that had an impact on the risk of knee arthroplasty included an ICRS grade of 3 to 4 (hazard ratio [HR], 3.1; 95% CI, 1.1 to 8.7), an age of ≥40 years at time of cartilage surgery (HR, 3.7; 95% CI, 1.8 to 7.7), a BMI of 25 to 29 kg/m2 (HR, 3.9; 95% CI, 1.7 to 9.0), a BMI of ≥30 kg/m2 (HR, 5.9; 95% CI, 2.4 to 14.3) at the time of follow-up, autologous chondrocyte implantation (ACI) at the time of the index procedure (HR, 3.4; 95% CI, 1.0 to 11.4), >1 focal cartilage lesion (HR, 2.1; 95% CI, 1.1 to 3.7), and a high preoperative visual analog scale (VAS) score for pain at the time of the index procedure (HR, 1.1; 95% CI, 1.0 to 1.1). The risk ratio of later knee arthroplasty in the cartilage cohort as compared with the age-matched general Norwegian population was 415.7 (95% CI, 168.8 to 1,023.5) in the 30 to 39-year age group.Conclusions:In the present study, we found that the 20-year cumulative risk of knee arthroplasty after a focal cartilage lesion in the knee was 19%. Deep lesions, higher age at the time of cartilage surgery, high BMI at the time of follow-up, ACI, and >1 cartilage lesion were associated with a higher risk of knee arthroplasty.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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

Cited by 9 publications

References 46 publications

Association of Postoperative Lateral Meniscal Extrusion With Cartilage Degeneration on Magnetic Resonance Imaging After Discoid Lateral Meniscus Reshaping Surgery

Association of Postoperative Lateral Meniscal Extrusion With Cartilage Degeneration on Magnetic Resonance Imaging After Discoid Lateral Meniscus Reshaping Surgery

Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

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