Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: the Multicenter Osteoarthritis study.

PURPOSE To assess the associations of meniscal tears, knee mal-alignment, cartilage damage, knee effusion, and body mass index with meniscal extrusion. MATERIALS AND METHODS The Multicenter Osteoarthritis study is an observational study of individuals who have or are at risk for knee osteoarthritis (OA). The HIPAA-compliant protocol was approved by the institutional review boards of all participating centers, and written informed consent was obtained from all patients. All subjects with available baseline knee radiographs and magnetic resonance (MR) images were included. MR imaging assessment of meniscal morphologic characteristics, meniscal position, and cartilage morphologic characteristics with use of the Whole-Organ Magnetic Resonance Imaging Score system was performed by two musculoskeletal radiologists. Cross-sectional associations of severity of meniscal tears, knee malalignment, tibiofemoral cartilage damage, knee effusion, and body mass index with meniscal extrusion were assessed by using logistic regression, with multiadjustments when testing each predictor. RESULTS A total of 1527 subjects (2131 knees; 2116 medial and 2106 lateral menisci) were included. Medially, meniscal tears, varus malalignment, and cartilage damage were associated with meniscal extrusion, with odds ratios (ORs) of 6.3 (95% confidence interval [CI]: 5.0, 8.0), 1.3 (95% CI: 1.1, 1.7), and 1.8 (95% CI: 1.4, 2.2), respectively. Laterally, meniscal tears, valgus malalignment, and cartilage damage were associated with meniscal extrusion, with ORs of 10.3 (95% CI: 7.1, 14.9), 2.2 (95% CI: 1.5, 3.2), and 2.0 (95% CI: 1.3, 2.9), respectively. CONCLUSION Meniscal tears are not the only factors associated with meniscal extrusion; other factors include knee malalignment and cartilage damage. Meniscal extrusion is probably an effect of the complex interactions among joint tissues and mechanical stresses involved in the OA process.

[1]  Richard Kijowski,et al.  Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging--diagnostic performance compared with that of conventional MR imaging at 3.0 T. , 2009, Radiology.

[2]  J. Carrino,et al.  Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? , 2004, AJR. American journal of roentgenology.

[3]  T. Miller,et al.  Meniscal position on routine MR imaging of the knee , 1997, Skeletal Radiology.

[4]  E. Roos,et al.  Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. , 1998, Arthritis and rheumatism.

[5]  P. Walker,et al.  The role of the menisci in force transmission across the knee. , 1975, Clinical orthopaedics and related research.

[6]  Ali Guermazi,et al.  Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study. , 2009, Arthritis and rheumatism.

[7]  M. Nevitt,et al.  A comparison of dedicated 1.0 T extremity MRI vs large-bore 1.5 T MRI for semiquantitative whole organ assessment of osteoarthritis: the MOST study. , 2010, Osteoarthritis and cartilage.

[8]  Ali Guermazi,et al.  Subchondral bone attrition may be a reflection of compartment-specific mechanical load: the MOST Study , 2009, Annals of the rheumatic diseases.

[9]  Xiaojuan Li,et al.  Loading of the knee during 3.0T MRI is associated with significantly increased medial meniscus extrusion in mild and moderate osteoarthritis. , 2012, European journal of radiology.

[10]  F. Cicuttini,et al.  Meniscal extrusion predicts increases in subchondral bone marrow lesions and bone cysts and expansion of subchondral bone in osteoarthritic knees. , 2010, Rheumatology.

[11]  M J Pearcy,et al.  Direct measurement of hoop strains in the intact and torn human medial meniscus. , 1996, Clinical biomechanics.

[12]  Ali Guermazi,et al.  Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging. , 2007, Arthritis and rheumatism.

[13]  Saara Totterman,et al.  The Clinical Importance of Meniscal Tears Demonstrated by Magnetic Resonance Imaging in Osteoarthritis of the Knee* , 2003, The Journal of bone and joint surgery. American volume.

[14]  J. Bloem,et al.  Do MRI features at baseline predict radiographic joint space narrowing in the medial compartment of the osteoarthritic knee 2 years later? , 2008, Skeletal Radiology.

[15]  F. Eckstein,et al.  The association of prevalent medial meniscal pathology with cartilage loss in the medial tibiofemoral compartment over a 2-year period. , 2010, Osteoarthritis and cartilage.

[16]  C. McCulloch,et al.  Associations of medial meniscal tear and extrusion with the sites of cartilage loss in the knee - Results from the Most study , 2008 .

[17]  R. Hirsch,et al.  Hip osteoarthritis prevalence estimates by three radiographic scoring systems. , 1998, Arthritis and rheumatism.

[18]  Felix Eckstein,et al.  Patterns of femorotibial cartilage loss in knees with neutral, varus, and valgus alignment. , 2008, Arthritis and rheumatism.

[19]  J. Sánchez-Guerrero,et al.  A connective tissue disease screening questionnaire for population studies. , 1995, Annals of epidemiology.

[20]  D A Bloch,et al.  Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging , 2004, Annals of the rheumatic diseases.

[21]  W. Maloney,et al.  Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. , 2009, The Journal of bone and joint surgery. British volume.

[22]  Trevor Hastie,et al.  Risk factors for progressive cartilage loss in the knee: a longitudinal magnetic resonance imaging study in forty-three patients. , 2002, Arthritis and rheumatism.

[23]  G. Tung,et al.  Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. , 2006, Radiology.

[24]  D J Hunter,et al.  Strong association of MRI meniscal derangement and bone marrow lesions in knee osteoarthritis: data from the osteoarthritis initiative. , 2009, Osteoarthritis and cartilage.

[25]  D. Finlay,et al.  Meniscal extrusion in young athletes: associated knee joint abnormalities. , 2006, AJR. American journal of roentgenology.

[26]  Richard Kijowski,et al.  Comparison of 1.5- and 3.0-T MR imaging for evaluating the articular cartilage of the knee joint. , 2009, Radiology.

[27]  K. Brandt,et al.  The relationship between meniscal tears and meniscal position , 2010, Therapeutic advances in musculoskeletal disease.

[28]  E. Roos,et al.  Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. , 2003, Arthritis and rheumatism.

[29]  B. Seedhom,et al.  Proceedings: Functions of the menisci. A preliminary study. , 1974, Annals of the rheumatic diseases.

[30]  M. Englund,et al.  Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. , 2004, Arthritis and rheumatism.

[31]  T. Magee.  MR findings of meniscal extrusion correlated with arthroscopy , 2008, Journal of magnetic resonance imaging : JMRI.

[32]  B. Marincek,et al.  MR Imaging of the Knee: Position Related Changes of the Menisci in Asymptomatic Volunteers , 2004, Investigative radiology.

[33]  J. Monllau,et al.  Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings , 2006, Knee Surgery, Sports Traumatology, Arthroscopy.

[34]  F. Cicuttini,et al.  Knee meniscal extrusion in a largely non-osteoarthritic cohort: association with greater loss of cartilage volume , 2007, Arthritis research & therapy.

[35]  H. Genant,et al.  Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. , 2004, Osteoarthritis and cartilage.

[36]  D. Resnick,et al.  Meniscal tears: role of axial MRI alone and in combination with other imaging planes. , 2004, AJR. American journal of roentgenology.

[37]  M. Nevitt,et al.  Tibiofemoral joint osteoarthritis: risk factors for MR-depicted fast cartilage loss over a 30-month period in the multicenter osteoarthritis study. , 2009, Radiology.

[38]  Felix Eckstein,et al.  Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. , 2008, Arthritis and rheumatism.

[39]  P. Bullough,et al.  The strength of the menisci of the knee as it relates to their fine structure. , 1970, The Journal of bone and joint surgery. British volume.

[40]  M. Nevitt,et al.  Meniscal pathology on MRI increases the risk for both incident and enlarging subchondral bone marrow lesions of the knee: the MOST Study , 2010, Annals of the rheumatic diseases.

[41]  Ali Guermazi,et al.  Incidental meniscal findings on knee MRI in middle-aged and elderly persons. , 2008, The New England journal of medicine.

[42]  D. Lerer,et al.  The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion , 2004, Skeletal Radiology.

[43]  A. D. De Smet,et al.  Use of the "two-slice-touch" rule for the MRI diagnosis of meniscal tears. , 2006, AJR. American journal of roentgenology.

[44]  J. Kellgren,et al.  Radiological Assessment of Osteo-Arthrosis , 1957, Annals of the rheumatic diseases.

[45]  Leena Sharma,et al.  Alignment and osteoarthritis of the knee. , 2009, The Journal of bone and joint surgery. American volume.

[46]  C. Choi,et al.  Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[47]  A Guermazi,et al.  The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis. , 2006, Arthritis and rheumatism.

[48]  Dae-Hee Lee,et al.  Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis , 2011, Knee Surgery, Sports Traumatology, Arthroscopy.