BOSTON — Preventing meniscal damage should be a top therapeutic priority in the fight against knee osteoarthritis, Dr. Martin Englund said at the annual meeting of the American College of Rheumatology.
Dr. Englund of Boston University and his colleagues in the Multicenter Osteoarthritis (MOST) study demonstrated for the first time that meniscal damage without surgical resection is a potent risk factor for the development of tibiofemoral radiographic knee osteoarthritis (OA).
No studies have demonstrated that meniscal damage without surgical resection is associated with the development of incident radiographic knee OA (ROA), he said.
The researchers conducted a nested case-control investigation comprising patients enrolled in the MOST study, which is a prospective observational study of 3,026 individuals older than age 50 who have or are at high risk of developing knee OA, excluding those who have had previous knee surgery. As per the MOST protocol, study participants underwent standardized, weight-bearing fixed-flexion x-rays at baseline and at 30 months, and these x-rays were read paired by a musculoskeletal radiologist and rheumatologist who were blinded to clinical and MRI data, Dr. Englund said.
For the current study, 52 knees that had no tibiofemoral ROA at baseline but had evidence of grade 2 or higher ROA on the Kellgren-Lawrence scale during the 30-month follow-up were case knees, and 130 knees drawn from the same source population but with no tibiofemoral ROA at follow-up served as controls.
To assess the baseline meniscal status of the knees included in the analysis, two musculoskeletal radiologists who were blinded to the case-control status of the knees reviewed coronal and sagittal fast spin echo MRI images and evaluated each for meniscal damage using a collapsed scale, whereby knees with no meniscal damage were graded as 0, those with a minor tear were considered grade 1, and those with a nondisplaced tear, displaced tear, maceration, or destruction were considered grade 2.
“Meniscal damage at baseline was significantly more common in cases than in controls,” Dr. Englund reported. Specifically, meniscal damage was evident in 52% of the case knees, compared with 18% of the control knees. When knees with meniscal damage were compared with knees that had a normal meniscus at baseline, the adjusted odds ratio for ROA at 30 months was 4.3 for knees with a meniscal score of 1 and 7.8 for those with a meniscal score of 2.
The findings highlight the need for better treatments and prevention of meniscal damage. Dr. Englund disclosed no financial conflicts related to his presentation.