US detection of medial meniscus extrusion can predict the risk of developing radiographic knee osteoarthritis: a 5-year cohort study

Abstract

Objectives

To clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA) through a 5-year follow-up.

Methods

Overall, 472 participants and 944 knees were eligible. MME (mm) was measured at the baseline, and KOA was radiographically evaluated at both baseline and 5-year follow-up by Kellgren-Lawrence grade (KLG). Radiographic KOA (ROA) was defined as the knee showing KLG ≥ 2. Incident ROA (iROA) was defined if the baseline KLG of 0–1 increased to KLG ≥ 2 in 5 years. Progressive ROA (pROA) was defined if the baseline KLG of 2–3 worsened to a higher grade in 5 years. Receiver operating characteristic (ROC) curve and generalized estimating equations were used for analysis.

Results

Of 574 non-ROA knees at the baseline, 43 knees (7.5%) developed iROA; of 370 ROA knees, 47 knees (12.7%) developed pROA. Based on the ROC curves, 4 mm was the optimal cutoff to detect the risk of iROA (area under curve [AUC] 0.639 [right knee]; AUC 0.641 [left knee]) and that of pROA (AUC 0.750 [right knee]; AUC 0.863 [left knee]). Multiple regression analysis showed that the 4-mm cutoff of MME was significantly associated with both the prevalence of iROA (regression coefficient [B] 1.909; p ≤ 0.001; adjusted odds ratio [aOR] 6.746) and that of pROA (B 1.791; p ≤ 0.001; aOR 5.993).

Conclusions

On ultrasonography, the participants with more extruded medial meniscus showed a higher prevalence of both iROA and pROA. Ultrasonography could identify patients who had a risk of developing KOA.

Key Points

• Through a 5-year follow-up, the current cohort study was conducted to clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA).

• More extruded medial meniscus evaluated by ultrasonography was associated with the development of radiographic KOA.

• Ultrasonography could identify the patients who had a risk of developing KOA, and the 4-mm cutoff of MME was optimal to detect this risk.

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Abbreviations

95% CI:

95% confidence interval

ADL:

Activities of daily living

aOR:

Adjusted odds ratio

AUC:

Area under the curve

BMI:

Body mass index

ICC:

Intraclass correlation coefficient

iROA:

Incident ROA

JSN:

Joint space narrowing

KLG:

Kellgren-Lawrence grade

KOA:

Knee osteoarthritis

KOOS:

Knee Injury and Osteoarthritis Outcome Scale

MME:

Medial meniscus extrusion

MOAKS:

MRI Osteoarthritis Knee Score

MRI:

Magnetic resonance image

pROA:

Progressive ROA

QOL:

Quality of life

ROA:

Radiographic knee osteoarthritis

ROC:

Receiver operating characteristic

WORMS:

Whole-Organ MRI Score

YI:

Youden’s Index

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Acknowledgments

We would like to acknowledge Editage (www.editage.com) for English language editing.

Funding

This study has received funding by the Ministry of Education, Culture, Sports, Science and Technology of Japan (No. 18200044), the Japanese Society for the Promotion of Science (No. 21500676), Karoji Memorial Fund for Medical Research (No. 5310139302), and JOA-Subsidized Science Project Research from the Japanese Orthopedic Association.

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Correspondence to Daisuke Chiba.

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Guarantor

The scientific guarantor of this publication is Daisuke Chiba.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical experience.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Arthritis Care & Research, Arthritis Research & Therapy, Clinical Rheumatology, International Orthopedics, Knee Surg Sports Traumatol Arthrosc., and Osteoarthritis and Cartilage.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Chiba, D., Sasaki, E., Ota, S. et al. US detection of medial meniscus extrusion can predict the risk of developing radiographic knee osteoarthritis: a 5-year cohort study. Eur Radiol 30, 3996–4004 (2020). https://doi.org/10.1007/s00330-020-06749-1

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Keywords

  • Knee osteoarthritis
  • Meniscus
  • Ultrasound
  • Cohort study