Tufts Medical Center, Boston, Massachusetts.
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Arthritis Rheumatol. 2019 Jul;71(7):1089-1100. doi: 10.1002/art.40826. Epub 2019 May 21.
To determine whether accelerated knee osteoarthritis (KOA) is preceded by, and characterized over time by, destabilizing meniscal tears or other pathologic changes.
We selected 3 sex-matched groups of subjects from the first 48 months of the Osteoarthritis Initiative, comprising adults who had a knee without KOA (Kellgren/Lawrence [K/L] radiographic grade <2) at baseline. Subjects in the accelerated KOA group developed KOA of K/L grade ≥3, those with typical KOA showed increased K/L radiographic scores, and those with no KOA had the same K/L grade over time. An index visit was the visit when the radiographic criteria for accelerated KOA and typical KOA were met (the no KOA group was matched to the accelerated KOA group). The observation period was up to 2 years before and after an index visit. Radiologists reviewed magnetic resonance (MR) images of the index knee and identified destabilizing meniscal tears (root tears, radial tears, complex tears), miscellaneous pathologic features (acute ligamentous or tendinous injuries, attrition, subchondral insufficiency fractures, other incidental findings), and meniscal damage in >2 of 6 regions (3 regions per meniscus: anterior horn, body, posterior horn). In addition, bone marrow lesions (BMLs) and cartilage damage on MR images were quantified. Linear mixed regression models were performed to analyze the results.
At 1 year before the index visit, >75% of adults with accelerated KOA had meniscal damage in ≥2 regions (odds ratio 3.19 [95% confidence interval 1.70-5.97] versus adults with typical KOA). By the index visit, meniscal damage in ≥2 regions was ubiquitous in adults with accelerated KOA, including 42% of subjects having evidence of a destabilizing meniscal tear (versus 14% of subjects with typical KOA). These changes corresponded to findings of larger BMLs and greater cartilage loss in the accelerated KOA group.
Accelerated KOA is characterized by destabilizing meniscal tears in a knee compromised by meniscal damage in >2 regions, and also characterized by the presence of large BMLs and greater cartilage loss.
确定加速性膝骨关节炎（KOA）是否先于并随时间推移而出现不稳定半月板撕裂或其他病理改变。
我们从 Osteoarthritis Initiative 的前 48 个月中选择了 3 个性别匹配的受试者组，这些受试者在基线时膝关节无 KOA（Kellgren/Lawrence [K/L] 放射学分级<2）。加速性 KOA 组的受试者发展为 K/L 分级≥3 的 KOA，典型 KOA 组的受试者 K/L 放射学评分增加，而无 KOA 的受试者在随访期间 K/L 分级保持不变。指数就诊是指符合加速性 KOA 和典型 KOA 放射学标准的就诊（无 KOA 组与加速性 KOA 组相匹配）。观察期为指数就诊前和后最长 2 年。放射科医生回顾了指数膝关节的磁共振（MR）图像，并确定了不稳定半月板撕裂（根部撕裂、放射状撕裂、复杂撕裂）、其他病理特征（急性韧带或肌腱损伤、磨损、软骨下不充分骨折、其他偶然发现）以及 6 个区域中的>2 个区域（每个半月板 3 个区域：前角、体部、后角）的半月板损伤。此外，对 MR 图像上的骨髓病变（BML）和软骨损伤进行了量化。采用线性混合回归模型进行分析。
在指数就诊前 1 年，>75%的加速性 KOA 成人在≥2 个区域有半月板损伤（比值比 3.19[95%置信区间 1.70-5.97]，与典型 KOA 成人相比）。在指数就诊时，加速性 KOA 成人的≥2 个区域半月板损伤普遍存在，包括 42%的受试者有不稳定半月板撕裂的证据（而典型 KOA 成人的受试者为 14%）。这些变化与加速性 KOA 组中更大的 BML 和更大的软骨损失相对应。
加速性 KOA 的特征是不稳定半月板撕裂，膝关节有>2 个区域的半月板损伤，还伴有大 BML 和更大的软骨损失。
