Katz Jeffrey N, Collins Jamie E, Brophy Robert H, Cole Brian J, Cox Charles L, Guermazi Ali, Jones Morgan H, Levy Bruce A, MacFarlane Lindsey A, Mandl Lisa A, Marx Robert G, Selzer Faith, Spindler Kurt P, Wright Rick W, Losina Elena, Chang Yuchiao
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Washington University School of Medicine, St. Louis, Missouri.
Arthritis Care Res (Hoboken). 2025 Mar;77(3):359-365. doi: 10.1002/acr.25197. Epub 2023 Oct 4.
Meniscal tear in persons aged ≥45 years is typically managed with physical therapy (PT), and arthroscopic partial meniscectomy (APM) is offered to those who do not respond. Prior studies suggest APM may be associated with greater progression of radiographic changes.
We assessed changes between baseline and 60 months in the Kellgren-Lawrence (KL) grade and OARSI radiographic score (including subscores for joint space narrowing and osteophytes) in subjects aged 45-85 years enrolled into a seven-center randomized trial comparing outcomes of APM with PT for meniscal tear, osteoarthritis changes, and knee pain. The primary analysis classified subjects according to treatment received. To balance APM and PT groups, we developed a propensity score and used inverse probability weighting (IPW). We imputed a 60-month change in the OARSI score for subjects who underwent total knee replacement (TKR). In a sensitivity analysis, we classified subjects by randomization group.
We analyzed data from 142 subjects (100 APM, 42 PT). The mean ± SD weighted baseline OARSI radiographic score was 3.8 ± 3.5 in the APM group and 4.0 ± 4.9 in the PT group. OARSI scores increased by a mean of 4.1 (95% confidence interval [95% CI] 3.5-4.7) in the APM group and 2.4 (95% CI 1.7-3.2) in the PT group (P < 0.001) due to changes in the osteophyte component. We did not observe statistically significant differences in the KL grade. Sensitivity analyses yielded similar findings to the primary analysis.
Subjects treated with APM had greater progression in the OARSI score because of osteophyte progression but not in the KL grade. The clinical implications of these findings require investigation.
年龄≥45岁的半月板撕裂患者通常采用物理治疗（PT），对无反应者则采用关节镜下部分半月板切除术（APM）。先前的研究表明，APM可能与影像学改变的更大进展相关。
我们评估了纳入一项七中心随机试验的45 - 85岁受试者在基线和60个月时的凯尔格伦 - 劳伦斯（KL）分级和骨关节炎研究学会（OARSI）影像学评分（包括关节间隙狭窄和骨赘的子评分）的变化，该试验比较了APM与PT治疗半月板撕裂、骨关节炎变化和膝关节疼痛的结果。主要分析根据接受的治疗对受试者进行分类。为平衡APM组和PT组，我们制定了倾向评分并使用逆概率加权（IPW）。我们对接受全膝关节置换（TKR）的受试者的OARSI评分的60个月变化进行了估算。在敏感性分析中，我们按随机分组对受试者进行分类。
我们分析了142名受试者的数据（100名接受APM，42名接受PT）。APM组加权基线OARSI影像学评分的均值±标准差为3.8±3.5，PT组为4.0±4.9。由于骨赘成分的变化，APM组的OARSI评分平均增加4.1（95%置信区间[95%CI] 3.5 - 4.7），PT组增加2.4（95%CI 1.7 - 3.2）（P < 0.001）。我们未观察到KL分级有统计学显著差异。敏感性分析得出的结果与主要分析相似。
接受APM治疗的受试者因骨赘进展导致OARSI评分有更大进展，但KL分级无进展。这些发现的临床意义需要进一步研究。
