title: Natural history and clinical significance of meniscal tears over 8 years in a midlife cohort.
abstract: BACKGROUND
  There is limited longitudinal data available on the natural history of meniscal tears especially in middle-aged adults with a low prevalence of osteoarthritis (OA). The aim of this study was to describe the natural history of meniscal tears over 8 years and the relationship with change in knee pain and structures.
  
  
  METHODS
  One hundred ninety eight participants [mean age 47 (28-63); 57% female] were studied at baseline and 8 years later. Approximately half were the adult offspring of subjects who had a knee replacement performed for knee OA and the remainder were randomly selected controls. Meniscal tears/extrusion, cartilage volume/defects, bone marrow lesions (BMLs) and effusion were assessed on MRI. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index.
  
  
  RESULTS
  22% of the participants had at least one meniscal tear at any site at baseline. Over 8 years, 16% of the participants had an increase in severity of meniscal tears while none improved. Increase in meniscal tear score was associated with worsening knee pain (β = +2.81 (+1.40, +4.22)), with offspring having a significantly greater increase in pain severity compared to controls. BMI and presence of osteophytes at baseline, but not knee injury, predicted change in tears, whereas change in meniscal tears was independently associated with cartilage volume loss, change in BMLs and change in meniscal extrusion.
  
  
  CONCLUSIONS
  Change in meniscal tears shares risk factors with knee OA and is independently associated with worsening knee pain and structural damage suggesting that meniscal tears are on the knee OA causal pathway.
authors.affiliation: Musculoskeletal Unit, Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23, 17-Liverpool Street, Hobart, TAS, 7000, Australia. Hussain.Khan@utas.edu.au.
authors.forename: Hussain Ijaz
authors.initials: HI
authors.lastname: Khan
authors.affiliation: Musculoskeletal Unit, Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23, 17-Liverpool Street, Hobart, TAS, 7000, Australia. Dawn.Aitken@utas.edu.au.
authors.forename: Dawn
authors.initials: D
authors.lastname: Aitken
authors.affiliation: Musculoskeletal Unit, Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23, 17-Liverpool Street, Hobart, TAS, 7000, Australia. ChangHai.Ding@utas.edu.au.
authors.forename: Changhai
authors.initials: C
authors.lastname: Ding
authors.affiliation: Musculoskeletal Unit, Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23, 17-Liverpool Street, Hobart, TAS, 7000, Australia. Leigh.Blizzard@utas.edu.au.
authors.forename: Leigh
authors.initials: L
authors.lastname: Blizzard
authors.affiliation: Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada. dr@jppelletier.ca.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pelletier
authors.affiliation: Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada. jm@martelpelletier.ca.
authors.forename: Johanne
authors.initials: J
authors.lastname: Martel-Pelletier
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Flavia.Cicuttini@monash.edu.
authors.forename: Flavia
authors.initials: F
authors.lastname: Cicuttini
authors.affiliation: Musculoskeletal Unit, Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23, 17-Liverpool Street, Hobart, TAS, 7000, Australia. Graeme.Jones@utas.edu.au.
authors.forename: Graeme
authors.initials: G
authors.lastname: Jones
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D013648:Tasmania / Q000453:epidemiology; D000070600:Tibial Meniscus Injuries; D013997:Time Factors