半月板损伤对膝骨关节炎发展的影响：来自骨关节炎倡议的数据。
The effects of meniscus injury on the development of knee osteoarthritis: data from the osteoarthritis initiative.
机构信息
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
Am J Sports Med. 2013 Jun;41(6):1238-44. doi: 10.1177/0363546513490276.
BACKGROUND
Osteoarthritis (OA) is a leading cause of pain and disability, and the knee is one of the most commonly affected joints. Many have speculated that injury to the meniscus may play a key role in the development of knee OA; however, the exact relationship of meniscus injury and knee OA is unknown.
PURPOSE
To examine the rate of meniscus injuries in patients with and without incident radiographic knee OA and to explore how the type, size, and location of the meniscus injury affects the development of OA.
STUDY DESIGN
Case-control study; Level of evidence, 3.
METHODS
A secondary case-control analysis was conducted of the Knee Osteoarthritis Initiative (OAI) database, which is a prospective, longitudinal, multicenter cohort study of knee health in patients at risk for knee OA. Eligible patients included those without radiographic OA at baseline in 1 knee. Thirty-two patients who developed radiographic OA in a previously unaffected knee after 2 years of follow-up were matched to 64 age-, sex-, and body mass index-matched patients who did not develop OA. The study analyzed the relationship between the development of OA and the presence of a meniscus tear or degenerative signal, meniscus extrusion, tear type, and size of injury on the baseline magnetic resonance imaging scans. Conditional logistic regression was used to identify significant predictors of OA.
RESULTS
The rate of medial meniscus lesions (tear or degeneration) was not significantly higher in those who developed incident OA (85%) compared with the control patients (68%; P = .07). However, medial meniscus extrusion (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.4-6.5), complex tears (OR, 5.0; 95% CI, 1.0-25), and tears with large radial involvement (OR, 5.92; 95% CI, 1.7-7.5) were more common at baseline in cases compared with controls.
CONCLUSION
Knees with meniscus tears with greater radial involvement and extrusion are at greater risk for later development of radiographic OA.
背景
骨关节炎（OA）是疼痛和残疾的主要原因，膝关节是最常受影响的关节之一。许多人推测半月板损伤可能在膝关节 OA 的发展中起关键作用；然而，半月板损伤与膝关节 OA 的确切关系尚不清楚。
目的
检查有和没有放射学膝关节 OA 事件的患者中半月板损伤的发生率，并探讨半月板损伤的类型、大小和位置如何影响 OA 的发展。
研究设计
病例对照研究；证据水平，3 级。
方法
对膝关节骨关节炎倡议（OAI）数据库进行了二次病例对照分析，该数据库是一项针对膝关节 OA 高危患者膝关节健康的前瞻性、纵向、多中心队列研究。符合条件的患者包括基线时 1 膝无放射学 OA 的患者。在 2 年随访后，32 例先前无病变的膝关节发生放射学 OA 的患者与 64 例年龄、性别和体重指数匹配的未发生 OA 的患者相匹配。本研究分析了 OA 发生与基线磁共振成像扫描中半月板撕裂或退行性信号、半月板挤出、撕裂类型以及损伤大小之间的关系。采用条件逻辑回归确定 OA 的显著预测因素。
结果
与对照组患者（68%；P =.07）相比，发生新发 OA 的患者（85%）内侧半月板病变（撕裂或退变）的发生率并不明显更高。然而，内侧半月板挤出（比值比 [OR]，3.03；95%置信区间 [CI]，1.4-6.5）、复杂撕裂（OR，5.0；95% CI，1.0-25）和大半径撕裂（OR，5.92；95% CI，1.7-7.5）在病例组中更为常见。
结论
半月板撕裂伴较大半径撕裂和挤出的膝关节发生放射学 OA 的风险更高。
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