Early Magnetic Resonance Imaging-Based Changes in Patients With Meniscal Tear and Osteoarthritis: Eighteen-Month Data From a Randomized Controlled Trial of Arthroscopic Partial Meniscectomy Versus Physical Therapy

Abstract

Objective: The present study was undertaken to evaluate changes in knee magnetic resonance imaging (MRI) findings over the course of 18 months in subjects with osteoarthritic change and meniscal tear treated with arthroscopic partial meniscectomy (APM) or nonoperatively with physical therapy (PT).

Methods: We used 18-month follow-up data from the Meniscal Tear in Osteoarthritis Research Trial. MRI results were read with reference to the MRI Osteoarthritis Knee Score. We focused on 18-month change in bone marrow lesions (BMLs), cartilage thickness, cartilage surface area, osteophyte size, effusion-synovitis, and Hoffa-synovitis. We used multinomial logistic regression to assess associations between MRI-based changes in each feature and treatment type.

Results: A total of 351 subjects were randomized, and 225 had both baseline and 18-month MRI results. In both treatment groups, patients experienced substantial changes in several MRI-based markers. In 60% of the APM group, versus 33% of the PT group, cartilage surface area damage advanced in ≥2 subregions (adjusted odds ratio 4.2 [95% confidence interval 2.0-9.0). Patients who underwent APM also had greater advancement in scores for osteophytes and effusion-synovitis. We did not find significant associations between treatment type and change in cartilage thickness, BMLs, or Hoffa-synovitis.

Conclusion: This cohort of patients with meniscal tear and osteoarthritis showed marked advancement in MRI-based features over 18 months. Patients treated with APM showed more advancement in some features compared to those treated nonoperatively. The clinical relevance of these early findings is unknown and requires further study.

Trial registration: ClinicalTrials.gov NCT00597012.

Figure 1.. Sample Details and analytic cohorts.

351 subjects were enrolled and randomized in the MeTeOR trial, and 225 had both baseline and 18 month MRI. 13 were excluded from all analyses, leaving 103 in the APM group, 37 in the APM to PT cross-over group, and 72 in the PT group. The primary analysis is APM (box I) vs. PT (box III). The first secondary analysis is as-treated: APM + APM to PT cross-over (box I + II) vs. PT (box III). The second secondary analysis is ITT: APM (box I) vs. APM to PT cross-over + PT (box II + III)

Figure 2.. Early MRI-Based Advancement in Cartilage and Osteophyte by Treatment Group (Primary Analysis).

Each panel shows the distribution of MRI-based advancement by treatment group, for A) Cartilage Surface Area, B) Cartilage Thickness, C) Osteophytes. Number of subregions with advancement is along the Y-axis and treatment group (APM vs. PT) is along the X-axis. Each small circle represents one participant. The diamond indicates the mean and the square indicates the median.

Figure 3.. Early MRI-Based Advancement in BML, Hoffa-Synovitis, and Effusion-Synovitis by Treatment Group (Primary Analysis).

Each panel shows the distribution of MRI-based advancement by treatment group, for A) Bone Marrow Lesion (BML), B) Hoffa-synovitis, C) Effusion-Synovitis. Advancement is along the Y-axis and treatment group (APM vs. PT) is along the X-axis. Advancement is measured in number of subregions for BML and in change in score for Hoffa-synovitis and Effusion-synovitis. Each small circle represents one participant. The diamond indicates the mean and the square indicates the median.