Patients who undergo surgery for meniscal tears have greater osteoarthritis progression
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Key takeaways:
- Patients who underwent arthroscopic meniscal surgery had more osteophyte progression than those who received physical therapy.
- There was no discernable difference regarding Kellgren-Lawrence grades.
Patients with osteoarthritis who undergo arthroscopic partial meniscectomy appear to demonstrate greater OARSI score progression via osteophytes, but not Kellgren-Lawrence grades, according to data published in Arthritis Care & Research.
“There has been increasing concern that arthroscopic meniscal surgery may be associated with greater progression of osteoarthritis,” Jeffrey N. Katz, MD, MSc, of Harvard Medical School, told Healio. “We examined that relationship in a randomized trial cohort of persons with meniscal tear who were followed for 5 years.”
To assess the association between arthroscopic partial meniscectomy (APM) and OA progression, Katz and colleagues analyzed data from the MeTeOR cohort, which examined meniscal tears in patients who were treated with APM vs. those who underwent a standard physical therapy regimen. Patients with severe OA were excluded from the original analysis, while Katz and colleagues further excluded those who did not participate in radiographic follow-ups, those who died before 60 months of follow-up, and those who did not have a baseline radiograph.
Patients underwent a standing bilateral posterior-anterior knee radiograph at baseline, 18 and 60 months. Radiographs were examined by three assessors who were blinded to the types of treatment. The researchers then evaluated the radiographs under two sets of context — OARSI scores and Kellgren-Lawrence grades.
The analysis included a total 142 patients, of whom 100 underwent APM and 42 completed a physical therapy regimen. The average OARSI score at baseline was 3.8 in patients who underwent APM and 4 in the group that performed physical therapy. After follow-up, patients who were treated with APM reported an average OARSI score increase of 4.1 (95% CI, 3.5-4.7), compared to an average increase of 2.4 (95% CI, 1.7-3.2) in the physical therapy group. According to the researchers, there was no statistically significant difference regarding Kellgren-Lawrence grades.
“We found that those who were treated with partial meniscectomy had greater progression in osteophytes on radiograph from baseline to 5 years than those treated nonoperatively,” Katz said. “We do not know whether these changes are clinically important. The takeaway for the clinician is that meniscal surgery may be related to greater progression of osteophytes.”