The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis

Abstract

Objective. To explore the role of meniscal tears and meniscal malposition as risk factors for subsequent cartilage loss in subjects with symptomatic osteoarthritis (OA).Methods. Study subjects were patients with symptomatic knee OA from the Boston Osteoarthritis of the Knee Study. Baseline assessments included knee magnetic resonance imaging (MRI) with followup MRI at 15 and 30 months. Cartilage and meniscal damage were scored on MRI in the medial and lateral tibiofemoral joints using the semiquantitative whole-organ magnetic resonance imaging score. Tibiofemoral cartilage was scored on MR images of all 5 plates of each tibiofemoral joint, and the meniscal position was measured using eFilm Workstation software. A proportional odds logistic regression model with generalized estimating equations was used to assess the effect of each predictor (meniscal position factor and meniscal damage as dichotomous predictors in each model) on cartilage loss in each of the 5 plates within a compartment. Models were adjusted for age, body mass index (BMI), tibial width, and sex.Results. We assessed 257 subjects whose mean ؎ SD age was 66.6 ؎ 9.2 years and BMI was 31.5 ؎ 5.7 kg/m 2 ; 42% of subjects were female, and 77% of knees had a Kellgren/Lawrence radiographic severity grade >2. In the medial tibiofemoral joint, each measure of meniscal malposition was associated with an increased risk of cartilage loss. There was also a strong association between meniscal damage and cartilage loss. Since meniscal coverage and meniscal height diminished with subluxation, less coverage and reduced height also increased the risk of cartilage loss.Conclusion. This study highlights the importance of an intact and functioning meniscus in patients with symptomatic knee OA, since the findings demonstrate that loss of this function has important consequences for cartilage loss.Cartilage loss in knee osteoarthritis (OA) is a multifactorial process that is influenced by systemic risk factors such as age, sex, and obesity and by local mechanical factors such as alignment and injury. One of the important local mechanical factors is the integrity and function of the meniscus. The meniscus has many functions in the knee, including load bearing, shock absorption, stability enhancement, and lubrication (1,2). Knee OA after meniscectomy is traditionally considered a result of the joint injury that leads to the meniscectomy in the first instance, and the increased contact stress in the cartilage due to the loss of meniscal tissue (3-8). Meniscectomy is often accompanied by the onset of OA because of the high focal stresses imposed on articular cartilage and subchondral bone subsequent to excision of the meniscus. Studies of meniscectomy affirm the importance of loss of meniscal function as a risk factor for subsequent knee OA (9).Although meniscectomy appears to be an important risk factor for OA, we know little about the effect of meniscal tears and meniscal extrusion or subluxation on cartilage loss in knees with preexisting OA. Results from a cross-sectio...

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

“…Loading and cartilage wear within the medial compartment appear to vary depending on factors such as the integrity of the anterior cruciate ligament (18,30,31), meniscal status (32,33), and joint malalignment (18,31). For example, one study found the greatest cartilage wear in the anterior regions in medial knee OA (34), whereas others have shown greater involvement in the posterior regions (18,31).…”

Inhibition of Matrix Metalloproteinases Enhances In Vitro Repair of the Meniscus

“…In addition to the pain and loss of function associated with a meniscal tear, damage and degenerative changes in the meniscus ultimately lead to loss of cartilage and development of OA [13,29,49,60], with 2 . 3 of patients having radiographic knee OA develop within 5 to 15 years [37].…”

Enhanced integrative repair of the porcine meniscus in vitro by inhibition of interleukin‐1 or tumor necrosis factor α

“…In addition, both partial meniscectomy and partially healed meniscal incisions in a canine model were shown to result in significant increases in cartilage chondropathy and decreased cartilage tensile properties (12). Furthermore, studies in patients with symptomatic knee OA have revealed that both meniscal damage and malposition are associated with an increased risk of cartilage loss (16). In patients with medial meniscal tears and extrusion, there is also a loss of medial cartilage volume and rapid disease progression in the medial compartment of the joint (17).…”