Osteoarthritis structural changes worsened in first 18 months after partial meniscectomy
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Patients with knee osteoarthritis who undergo arthroscopic partial meniscectomy experience “heightened” progression in osteophytes, cartilage surface area and effusion-synovitis from baseline to 18 months, according to data.
“Participants treated with [arthroscopic partial meniscectomy (APM)] showed heightened progression in osteophytes, cartilage surface area, and effusion-synovitis from baseline to 18 months, but only osteophytes remained significantly different between treatment groups over the subsequent 18- to 60-month time period,” Jaime E. Collins, PhD, of Brigham and Women’s Hospital and Harvard Medical School, in Boston, and colleagues wrote in Arthritis and Rheumatology.
To examine the risk for MRI-based structural changes in patients with OA and meniscal tear who received APM, compared with those treated with physical therapy or sham procedures, Collins and colleagues analyzed data from the Meniscal Tear in Osteoarthritis Research (MeTeOR).
The final sample included 302 eligible participants who had at least one MRI from baseline, 18 months or 60 months available, and who did not cross from physical therapy to APM following randomization. Among the participants, 70% had a meniscal tear in the medial compartment, 15% had a tear in the lateral compartment and 14% had a tear in both.
Compared with the physical therapy group, patients who received APM demonstrated a roughly 0.7-point greater worsening per 12 months between baseline and 18 months (95% CI, 0.1-1.3), and a 0.3-point greater worsening per 12 months between 18 and 60 months (95% CI, 0.0-0.5), according to the researchers.
“In both sets of analyses, participants in the APM group appeared to be at elevated risk of MRI-based worsening compared to [physical therapy (PT)] group over baseline to 18 months, but not over 18 to 60 months,” the researchers wrote in reference to cartilage surface area damage.
In measuring cartilage thickness damage, participants in the intent-to-treat and as-treated analyses had insignificant worsening in thickness, compared with the group that received physical therapy, through 18 months. Differences among patient groups in bone marrow lesions were insignificant through 18 months and “close to zero” through 60 months, according to the researchers.
“Progression in osteophytes was significantly greater in the APM group from 18 months to 60 months post-randomization; however, we did not observe differences between the two treatment groups in progression of the other MRI parameters from 18 to 60 months,” the researchers wrote.
Study limitations include the fact that 30% of participants in the MeTeOR study crossed over from physical therapy to APM in the first 6 months, as well as “substantial dropout” before 60 months.
“The clinical meaning of these findings remains uncertain,” Collins and colleagues wrote. “Further research is required to determine the relationship of these structural changes to symptoms and other patient-centered outcomes.”
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