Patients with meniscal extrusion more likely to develop knee osteoarthritis
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Patients with knees that demonstrate meniscal extrusion are more likely to develop osteoarthritis over the long term, according to data published in Seminars in Arthritis and Rheumatism.
“In recent years, the role of the meniscus in the development and progression of knee osteoarthritis (OA) has become more acknowledged, with meniscal pathology, including extrusion, being a common finding in knees with established OA,” Jan A. van der Voet, MD, of the department of radiology and nuclear medicine at Erasmus MC University Medical Center, in the Netherlands, and colleagues wrote. “To date it is not completely clarified whether extrusion precedes OA development or whether it is a consequence of the degenerative process.”
To examine the association between meniscal extrusion with long-term incident knee OA, van der Voet and colleagues analyzed data from two cohorts that focused on long-term incident OA — the PROOF and Rotterdam studies. According to the researchers, PROOF was a large, prospective intervention study, while the Rotterdam study was a prospective, population-based cohort. In both studies, participants were measured for body weight, height, knee alignment and maximum quadriceps muscle strength scores. Additionally, both studies defined meniscal extrusion as a grade 2 or 3 extrusion. Extrusions in grade 0 or 1 categories were considered “no extrusion.”
Outcome measures of interest included incident radiographic or clinical knee OA. Radiographic OA was defined as a Kellgren & Lawrence score of two or more in knees with a baseline of less than two. Clinical OA was defined using official American College of Rheumatology criteria.
In PROOF, the researchers analyzed 421 knees, 23% of which demonstrated meniscal extrusion at baseline. According to the van der Voet and colleagues, radiographic knee OA was “significantly higher” in knees with meniscal extrusion compared with knees without meniscal extrusion (adjusted OR = 2.54; 95% CI, 1.34-4.8). Incident clinical OA was also higher in the group with meniscal extrusion (aOR = 2.44; 95% CI, 1.29-4.6).
Meanwhile, in the Rotterdam study, the researchers analyzed 872 knees, of which 46% had meniscal extrusion. In this cohort, incident radiographic OA was higher in patients with meniscal extrusion (aOR = 9.86; 95% CI, 2.13-45.67), while incident clinical OA was “borderline significantly higher” in those with meniscal extrusion (aOR = 2.65; 95% CI, 0.96-7.3).
“With the present study we provided further evidence that meniscus extrusion also in the long term is largely independently associated with the development of radiographic and clinical knee OA, with clearly higher incidences of knee OA in both cohorts,” van der Voet and colleagues wrote. “The high population attributable risk percentage reflects the relevance of these results and indicates the possible impact on public health.”
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Van der Voet JA, et al. Semin Arthritis Rheumatism. 2023;doi:10.1016/j.semarthrit.2023.152170.
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