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Multicenter Study
. 2011 Oct;70(10):1733-9.
doi: 10.1136/ard.2011.150052. Epub 2011 Jun 6.

Risk factors for medial meniscal pathology on knee MRI in older US adults: a multicentre prospective cohort study

Martin Englund  1 , David T Felson, Ali Guermazi, Frank W Roemer, Ke Wang, Michel D Crema, John A Lynch, Leena Sharma, Neil A Segal, Cora E Lewis, Michael C Nevitt
Affiliations
Multicenter Study

Risk factors for medial meniscal pathology on knee MRI in older US adults: a multicentre prospective cohort study

Martin Englund et al. Ann Rheum Dis. 2011 Oct.

Abstract

Objectives: Meniscal pathology in which the aetiology is often unclear is a frequent finding on knee MRI. This study investigates potential risk factors for medial meniscal lesions or extrusion in middle-aged and elderly persons.

Methods: Prospective cohort study using population-based subjects from Birmingham, Alabama and Iowa City, Iowa, USA (the Multicenter Osteoarthritis Study). 644 men and women aged 50-79 years with or at high risk of knee osteoarthritis (Kellgren and Lawrence grade 0-2) but with normal medial meniscal status at baseline were studied. Paired baseline and 30-month 1.0 T knee MRI were scored for meniscal lesions and extrusion (pathology) and the following systemic, knee-specific and compartment-specific potential risk factors were evaluated: age, sex, body mass index, bony enlargement of finger joints, knee trauma, leg-length inequality and knee alignment.

Results: Of 791 knees, 77 (9.7%) had medial meniscal pathology at 30 months follow-up. 61 of the 77 (81%) had no report of trauma during follow-up. Including all potential risk factors in the multivariable model, the adjusted OR for medial meniscal pathology was 4.14 (95% CI 2.06 to 8.31) for knee trauma during follow-up, 1.64 (1.00 to 2.70) for five or more bony enlargements of finger joints (vs ≤ 4) and 2.00 (1.18 to 3.40) for varus alignment (vs not varus) at baseline examination. Obesity was a risk factor for the development of meniscal extrusion, OR 3.04 (1.04 to 8.93) but not for meniscal lesions, OR 1.15 (0.52 to 2.54).

Conclusions: Apart from knee trauma, possible generalised osteoarthritis, expressed as multiple bony enlargements of finger joints, varus alignment and obesity are risk factors for medial meniscal pathology.

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Conflict of interest statement

POTENTIAL COMPETING INTERESTS

AG is shareholder of Boston Imaging Core Lab, LLC (BICL), Boston, Massachusetts, USA, a company providing radiological image assessment services, and Synarc Inc, and consultant to Merck Serono, Novartis, Genzyme, Facet Solutions and Stryker. FWR and MDC are shareholders of BICL. None of the other authors have declared any conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart (please note that a person may contribute with one knee to the analysis while the other knee was excluded). MOST=Multicenter Osteoarthritis Study, MRI=magnetic resonance imaging
Figure 2
Figure 2. Meniscal tear
A) Baseline sagittal fat-suppressed proton density-weighted 1.0T MRI shows normal triangular appearance of the posterior horn of the medial meniscus without tear or intramensical signal alterations. B) Follow-up image shows a meniscal tear reaching the superior and inferior surface of the posterior horn (arrow).
Figure 3
Figure 3. Partial meniscal maceration
A) Baseline coronal 1.0T STIR MRI shows a normal body of the medial meniscus. B) 30 months follow-up image shows partial maceration of the meniscal body with an amputated triangular appearance (arrow).
Figure 4
Figure 4. Meniscal extrusion
A) Baseline coronal 1.0T STIR MRI depicts a normal position of the body of the medial meniscus in alignment with the tibial plateau. B) The 30-months follow-up image shows medial meniscal extrusion of 3 mm in regard to the tibial plateau (arrow).
See this image and copyright information in PMC

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