Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi Prefecture, 980-8574, Japan.
Omagari Orthopaedic Clinic, 11-6-8 Ohanacho, Daisen, Akita Prefecture, 014-0022, Japan.
J Orthop Sci. 2021 Sep;26(5):844-849. doi: 10.1016/j.jos.2020.09.001. Epub 2020 Oct 5.
Obesity is a representative risk factor for osteoarthritis (OA). The relationship between osteoporosis and executed osteonecrosis has been reported. The primary aim of this study was to determine the influence of obesity and osteoporosis on disease progression in patients with medial meniscus posterior root tear (MMPRT).
We included 41 knees with MMPRT in this study. MMPRT was diagnosed based on the presence of both a meniscus ghost sign and a vertical linear defect on MRI. OA progression and development of osteonecrosis were evaluated using plain radiographs obtained at the initial visit and the final follow-up. The follow-up period for all knees was 30 ± 8 (mean ± standard deviation) months. Patients' physical attributes were assessed at initial visits; these attributes included body mass index (BMI) and the clinical risk for osteoporotic fracture, as determined by the World Health Organization fracture risk assessment tool (FRAX). Patients with a BMI ≥25 kg/m were classified in the obesity group and those with a BMI <25 kg/m in the control group. Patients with a FRAX score of ≥10% were classified in the high FRAX group and those with a FRAX score of <10% in the low FRAX group.
OA progression evaluated by Kellgren-Lawrence grading scale was observed in 75% patients in the obesity group (1 grade in 38%, 2 grades in 31%, and 3 grades in 6%) and 58% in the control group (1 grade in 58%). Patients in the obesity group showed significantly greater OA progression. Spontaneous osteonecrosis was observed in no knees at the initial visit and six knees at the final follow-up. All six lesions were observed in the high FRAX group, which was statistically significant.
OA progression and development of osteonecrosis were the two representative deterioration patterns in patients with MMPRT. High BMI was related with OA progression, and FRAX score of ≥10% with the development of osteonecrosis.
肥胖是骨关节炎（OA）的代表性危险因素。已经报道了骨质疏松症与执行性骨坏死之间的关系。本研究的主要目的是确定肥胖和骨质疏松症对内侧半月板后根撕裂（MMPRT）患者疾病进展的影响。
我们纳入了 41 例患有 MMPRT 的膝关节。根据 MRI 上存在半月板幽灵征和垂直线性缺陷来诊断 MMPRT。在初次就诊和最终随访时获得的 X 线片评估 OA 进展和骨坏死的发展。所有膝关节的随访时间为 30±8（平均值±标准差）个月。在初次就诊时评估患者的身体特征；这些特征包括体重指数（BMI）和世界卫生组织骨折风险评估工具（FRAX）确定的骨质疏松性骨折临床风险。BMI≥25kg/m2 的患者归入肥胖组，BMI<25kg/m2 的患者归入对照组。FRAX 评分≥10%的患者归入高 FRAX 组，FRAX 评分<10%的患者归入低 FRAX 组。
肥胖组（38%的 1 级、31%的 2 级和 6%的 3 级）有 75%的患者（75%）出现 KL 分级的 OA 进展，对照组（58%）有 58%的患者（58%）出现 OA 进展。肥胖组的 OA 进展明显更大。在初次就诊时没有膝关节出现自发性骨坏死，在最终随访时有 6 个膝关节出现自发性骨坏死。所有 6 个病变均发生在高 FRAX 组，具有统计学意义。
MMPRT 患者的两种代表性恶化模式是 OA 进展和骨坏死的发展。高 BMI 与 OA 进展有关，FRAX 评分≥10%与骨坏死的发展有关。
