Early Magnetic Resonance Imaging–Based Changes in Patients With Meniscal Tear and Osteoarthritis: Eighteen‐Month Data From a Randomized Controlled Trial of Arthroscopic Partial Meniscectomy Versus Physical Therapy

Abstract

Objective. The present study was undertaken to evaluate changes in knee magnetic resonance imaging (MRI) findings over the course of 18 months in subjects with osteoarthritic change and meniscal tear treated with arthroscopic partial meniscectomy (APM) or nonoperatively with physical therapy (PT).Methods. We used 18-month follow-up data from the Meniscal Tear in Osteoarthritis Research Trial. MRI results were read with reference to the MRI Osteoarthritis Knee Score. We focused on 18-month change in bone marrow lesions (BMLs), cartilage thickness, cartilage surface area, osteophyte size, effusion-synovitis, and Hoffa-synovitis. We used multinomial logistic regression to assess associations between MRI-based changes in each feature and treatment type.Results. A total of 351 subjects were randomized, and 225 had both baseline and 18-month MRI results. In both treatment groups, patients experienced substantial changes in several MRI-based markers. In 60% of the APM group, versus 33% of the PT group, cartilage surface area damage advanced in ≥2 subregions (adjusted odds ratio 4.2 [95% confidence interval 2.0-9.0). Patients who underwent APM also had greater advancement in scores for osteophytes and effusion-synovitis. We did not find significant associations between treatment type and change in cartilage thickness, BMLs, or Hoffa-synovitis.Conclusion. This cohort of patients with meniscal tear and osteoarthritis showed marked advancement in MRI-based features over 18 months. Patients treated with APM showed more advancement in some features compared to those treated nonoperatively. The clinical relevance of these early findings is unknown and requires further study.Recent estimates suggest that 14 million adults in the US have knee osteoarthritis (OA), including 8 million individuals under 65 years of age (1). Of these, ~80% have a concomitant meniscal tear (2). Nonoperative treatment of symptomatic meniscal tear typically includes a physical therapy (PT) regimen (muscle strengthening, endurance, flexibility, and balance training). Surgical treatment ClinicalTrials.gov identifier: NCT00597012.

Minimally Invasive Polarization Sensitive Optical Coherence Tomography (PS-OCT) for assessing Pre-OA, a pilot study on technical feasibility

“…But in studying if abnormal PS-OCT measurements predict progression to OA, this patient population has advantages. First, our data is consistent with previous reports that a significant percentage of these patients progressed to frank OA (over a short time period) in the medial tibial plateau [ 31 – 33 ]. Second, using this patient population will allow evaluation, by the arthroscope, of the new stiffer endocatheter’s maneuverability as was done in this feasibility study.…”

Radiographic Changes Five Years After Treatment of Meniscal Tear and Osteoarthritic Changes

“…Our findings align with those of Collins et al, who documented greater progression in MRI‐defined cartilage defects, osteophytes, bone marrow lesions, and synovitis in MeTeOR trial participants treated with APM than in those treated nonoperatively (13,14). Sonesson et al documented that 3 years following randomization to APM versus exercise, 60% of APM‐treated subjects had a KL grade of ≤2 compared with 37% of nonoperatively treated subjects ( P = 0.06) (16).…”

Two-year MRI-defined structural damage and patient-reported outcomes following surgery or exercise for meniscal tears in young adults

“…Our study, including young patients, found less structural worsening over 2 years than in previous studies, including older patients with degenerative meniscal tears 6 7 23. Moreover, in contrast to an earlier trial comparing APM with physiotherapy for degenerative meniscal tears in older patients with radiographic knee OA that reported significantly greater MRI-defined worsening of cartilage damage and osteophytes in the APM group compared with the exercise group,23 we did not detect a difference between groups.…”