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.

Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial

“…Another recently published 5 year follow-up of a randomised trial reported radiographic deterioration in 60% of patients in the surgery group and 37% in the non-surgery group (p=0.060). 32 However, all this evidence is subject to considerable uncertainties, as the observational data are prone to confounding by indication while the trial data 30 32 are hampered by high rates of crossover (around 25–30%) from non-operative treatment to surgery during the follow-up and high loss to follow-up (around 30%).…”

“…The first, reporting the progression of MRI-based osteoarthritis markers over the first 18 months, suggested that patients undergoing APM had greater advancement of osteoarthritis than those treated non-operatively. 30 The second, a 5 year follow-up reporting both patient-reported outcomes and the incidence of total knee replacements (TKR), found no between-group difference in knee pain or function, but a greater likelihood of TKR was observed (HR 2.0, 95% CI 0.8 to 4.9) for participants randomised to APM, compared with those randomised to physical therapy. 31 Of note, the as-treated analysis of these data suggested that those exposed to APM over the follow-up period had a fivefold increased risk of TKR as compared with those allocated to physical therapy (HR 4.9, 95% CI 1.1 to 20.9).…”

Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial

“…Using the same cut-off, we found the incidence to be higher (16%), which may reflect the longer follow-up time. One study evaluates changes in MRI-based features 30 , but in contrast to the present study included predominantly patients with established knee osteoarthritis 31 . Over 18 months the surgery group showed greater advancement in cartilage surface area, osteophytes, and effusion-synovitis 30 .…”

“…One study evaluates changes in MRI-based features 30 , but in contrast to the present study included predominantly patients with established knee osteoarthritis 31 . Over 18 months the surgery group showed greater advancement in cartilage surface area, osteophytes, and effusion-synovitis 30 . The assessment of osteoarthritis markers on MRI is an important distinction to the present study and may explain the difference in the results.…”

Structural change following treatment for meniscal tear and osteoarthritis – the jury is still out

“…Results were similar in terms of patient-reported outcomes, with both studies showing substantial improvement in pain and function sustained over 5 years in both treatment groups. However, the MeTeOR trial found five-fold greater utilization of total knee arthroplasty (TKA) over 5 years in surgically-treated patients than those treated nonoperatively, and increased odds of progression in MRI-based cartilage, osteophyte, and effusion-synovitis scores over 18 months 3,4 . These analyses adjusted for baseline pain level and structural severity.…”