Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Orthop Res. 2020 Nov;38(11):2495-2504. doi: 10.1002/jor.24672. Epub 2020 Apr 3.
We sought to use publicly available data from the Osteoarthritis Initiative (OAI), a multicenter prospective cohort study, to determine the rate of joint space loss and likelihood of knee arthroplasty due to magnetic resonance imaging (MRI)-diagnosed meniscal tears or meniscal extrusion in middle-aged adults with no to mild knee osteoarthritis. Participants (n = 2199; mean age, 60.2 years) with Kellgren-Lawrence osteoarthritis grades 2 (mild) (48.7%) or 0 to 1 (none) (51.3%) underwent knee MRIs at enrollment and were followed radiographically for 8 years and for total knee arthroplasty (TKA) for 9 years. Rate of joint space loss and risk of arthroplasty due to meniscal tears and/or extrusion were determined by multivariate modeling. Prevalence of baseline medial meniscus tears was 21.3% and lateral tears was 12.8%; 26.9% had medial meniscal extrusion (79.6%, <2 mm; 20.4%, +2 mm) and 5.4% had lateral extrusion (75.9%, <2 mm; 24.1%, +2 mm). Median medial joint space loss was 0.06 mm/y and lateral was 0.05 mm/y. Medial tears regardless of extrusion were associated with accelerated medial joint space loss (additional mean, 0.05 mm/y; P = .001). Lateral tears were associated with accelerated lateral joint space loss (additional 0.09 mm/y; P < .001) as was lateral extrusion (additional 0.10 mm/y; P < .001). The yearly incidence of knee arthroplasty was 0.5% without lateral extrusion, 1.5% with extrusion less than 2.0 mm, and 3.7% with extrusion greater than or equal to 2.0 mm. Both medial and lateral tears accelerate joint space loss in middle-aged adults. Lateral meniscal extrusion further accelerates joint space loss and increases risk of progression to TKA within 9 years.
我们试图利用 Osteoarthritis Initiative（OAI）的公开数据，这是一项多中心前瞻性队列研究，来确定在没有到轻度膝关节骨关节炎的中年人群中，由于 MRI 诊断的半月板撕裂或半月板外突导致的关节间隙损失率以及膝关节置换术的可能性。参与者（n=2199；平均年龄 60.2 岁）的 Kellgren-Lawrence 骨关节炎分级为 2（轻度）（48.7%）或 0 到 1（无）（51.3%），在入组时进行膝关节 MRI 检查，并进行了 8 年的放射学随访和 9 年的全膝关节置换术（TKA）随访。通过多变量模型确定关节间隙损失率和因半月板撕裂和/或外突导致的关节置换风险。基线内侧半月板撕裂的患病率为 21.3%，外侧为 12.8%；26.9%有内侧半月板外突（79.6%，<2mm；20.4%，+2mm），5.4%有外侧外突（75.9%，<2mm；24.1%，+2mm）。内侧关节间隙的中位数损失为 0.06mm/y，外侧为 0.05mm/y。无论是否有外突，内侧撕裂都与内侧关节间隙加速损失相关（额外平均 0.05mm/y；P=0.001）。外侧撕裂与外侧关节间隙加速损失相关（额外 0.09mm/y；P<.001），外侧外突也是如此（额外 0.10mm/y；P<.001）。没有外侧外突的膝关节置换术年发生率为 0.5%，外突小于 2.0mm 的发生率为 1.5%，外突大于或等于 2.0mm 的发生率为 3.7%。内侧和外侧撕裂都会加速中年人群的关节间隙损失。外侧半月板外突进一步加速关节间隙损失，并增加 9 年内进展为 TKA 的风险。
