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Both partial meniscectomy, physical therapy linked with MRI-based progression in patients with meniscal tears, OA
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Changes in MRI-based features progressed in patients with meniscal tears and osteoarthritis regardless of whether they underwent arthroscopic partial meniscectomy or were treated nonoperatively and underwent physical therapy, according to published research.
“In a follow-up evaluation of data from of an [randomized controlled trial] RCT of [arthroscopic partial meniscectomy] APM vs. nonoperative therapy, we found that patients undergoing APM had an increased odds of advancement in MRI-based structural features, including cartilage, osteophytes and effusion-synovitis compared to those undergoing nonoperative therapy,” study author Jamie E. Collins, PhD, told Healio.com/Orthopedics. “This suggests that APM may be associated with an increased risk of OA progression beyond that posed by the underlying meniscal damage. However, these results should be interpreted with caution as the clinical relevance of these findings requires further study and as we evaluate these patients over longer follow-up.”
Researchers used 18-month follow-up data from the Meniscal Tear in Osteoarthritis Research Trial of 351 patients randomly assigned to undergo either arthroscopic partial meniscectomy or nonoperative treatment with physical therapy. The MRI OA knee score was used to evaluate MRIs. There were 225 patients with baseline and 18-month MRIs. Investigators evaluated 18-month change in bone marrow lesions, cartilage thickness, cartilage surface area, osteophytes size, effusion-synovitis and Hoffa-synovitis. Associations between MRI-based changes in each feature and the type of treatment were assessed with multinomial logistic regression.
Results showed patients who underwent arthroscopic partial meniscectomy and patients who received nonoperative treatment with physical therapy had substantial changes in the various MRI-based markers. The cartilage surface area damage advanced in two or more subregions for 60% of patients who underwent surgery and for 33% of patients who underwent physical therapy. Scores for osteophytes and effusion-synovitis improved more in patients who underwent arthroscopic partial meniscectomy compared to those who received physical therapy. There were no significant correlations between the type of treatment and the change in cartilage thickness, bone marrow lesions or Hoffa-synovitis. – by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
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Collins JE, et al. Arthritis Care Res (Hoboken). 2019;doi:10.1002/acr.23891.
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