The relationship between meniscal pathology and osteoarthritis depends on the type of meniscal damage visible on magnetic resonance images: data from the Osteoarthritis Initiative

Abstract

Objective To determine the association of different types of meniscal pathology with common measures of osteoarthritis severity and progression: knee pain, bone marrow lesion (BML) volume, and end-stage knee osteoarthritis (esKOA). Design Participants were selected from an ancillary project to the Osteoarthritis Initiative (OAI) who had at least one knee with symptomatic osteoarthritis. Baseline magnetic resonance images (MRI) were evaluated for meniscal pathology using a modified International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) classification system. We collapsed 10 types of meniscal pathology into 5 categories: normal, intrameniscal signal, morphological deformity/extrusion (altered meniscal shape and/or extrusion but no apparent substance loss), tear, and maceration. Outcomes included WOMAC knee pain and BML volume at baseline and after 2-years. We defined the prevalence of esKOA based on a validated algorithm. We performed logistic regression and adjusted for age, sex, and body mass index (BMI). Results The 463 participants (53% male) included in the analysis had mean age 63 (9.2) years, BMI 29.6 (4.6) kg/m2, and 71% had Kellgren-Lawrence grade≥2. Morphological deformity/extrusion and maceration, but no other types of meniscal pathology, were associated with BML volume (morphological deformity/extrusion odds ratio [OR]=2.47,95%CI:1.49,4.09, maceration OR=5.85,95%CI:3.40,10.06) and change in BML volume (morphological deformity/extrusion OR=2.17,95%CI:1.37,3.45, maceration OR=3.12,95%CI:1.87,5.19). Only maceration was associated with baseline WOMAC knee pain (OR=2.82,95%CI:1.79,4.43) and prevalence of esKOA (OR=7.53,95%CI:4.25,13.31). Conclusions Based on MRI, morphologic deformity/extrusion and maceration rather than intrameniscal signal or tear were associated with osteoarthritis severity and progression, which highlights the importance of differentiating distinct types of meniscal pathology.

Meniscus ECM‐functionalised hydrogels containing infrapatellar fat pad‐derived stem cells for bioprinting of regionally defined meniscal tissue

“…Following a meniscectomy, consisting of the surgical removal of all or part of damaged meniscus tissue, the intrinsic regeneration capacity remains poor, especially when a wide area of the tissue is resected. In addition, although partial meniscectomies often relieve symptoms in the short‐term, long‐term follow‐up indicates that meniscal removal leads to an increased risk of osteoarthritis, which may be explained by the fact that such a substantial loss of meniscal tissue alters the biomechanical and biological environment of the joint (Antony et al, ). No intervention (i.e., meniscectomy, intra‐articular cell delivery, and gene therapy) has been developed to facilitate true regeneration of an injured meniscus (Moran, Busilacchi, Lee, Athanasiou, & Verdonk, ; Scotti, Hirschmann, Antinolfi, Martin, & Peretti, ).…”

Associations among meniscal damage, meniscal symptoms and knee pain severity

“…If a subject had both root tear and maceration, he or she was classified as ‘root tear’ because clinically root tear was felt to be higher (worst) in the pain hierarchy. The hierarchy was based on the clinically important effects these tear types have on pain as evidenced by prior literature and the insight of senior orthopedic surgeons 14, 15 . We further categorized meniscal damage by creating a binary indicator for root tear.…”

“…We developed hypotheses based on the clinically important effects these tear types have on clinical symptoms and pain as evidenced by prior literature and the insight of senior orthopedic surgeons 4, 14, 15 . We hypothesized that simple tears, defined as vertical or radial tears, would be associated with mechanical symptoms (clicking, catching, popping) reflecting the effect of mobile meniscal tissue interfering with smooth joint motion.…”

Characterizing the distinct structural changes associated with self‐reported knee injury among individuals with incident knee osteoarthritis: Data from the osteoarthritis initiative

“…The readers scored infrapatellar synovitis, meniscal extrusion (medial and lateral), and bone attrition as normal, mild, moderate, or severe. Meniscal pathology was assessed in 3 regions (anterior, body, posterior) of each meniscus based on the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine meniscal tear classification: normal, degeneration, horizontal, flap horizontal, vertical longitudinal, radial, long radial, morphologic deformity, maceration, complex, or vertical flap tear (Anderson et al, 2011;Antony et al, 2017). Readers had good inter-observer agreement on the presence of each pathology among 25 cases: prevalenceadjusted and bias-adjusted kappa were 0.41 to 0.75, except for the posterior medial meniscus where the PABAK was fair at 0.25 (50% agreement).…”