title: The relationship between meniscal pathology and osteoarthritis depends on the type of meniscal damage visible on magnetic resonance images: data from the Osteoarthritis Initiative.
abstract: To determine the association of different types of meniscal pathology with knee pain, bone marrow lesion (BML) volume, and end-stage knee osteoarthritis (esKOA).
  
  
  
  Participants were selected from an ancillary project to the Osteoarthritis Initiative (OAI) who had at least one knee with symptomatic osteoarthritis. Baseline magnetic resonance images (MRI) were evaluated for meniscal pathology using a modified International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) classification system. We collapsed 10 types of meniscal pathology into five categories: normal, intrameniscal signal, morphological deformity/extrusion (altered meniscal shape and/or extrusion but no apparent substance loss), tear, and maceration. Outcomes included Western Ontario and McMaster Universities osteoarthritis index (WOMAC) knee pain and BML volume at baseline and after 2 years. We defined the prevalence of esKOA based on a validated algorithm. We performed logistic regression and adjusted for age, sex, and body mass index (BMI).
  
  
  
  The 463 participants (53% male) included in the analysis had mean age 63 (9.2) years, BMI 29.6 (4.6) kg/m2, and 71% had Kellgren-Lawrence grade ≥2. Morphological deformity/extrusion and maceration, but no other types of meniscal pathology, were associated with BML volume (morphological deformity/extrusion odds ratio [OR] = 2.47, 95% CI: 1.49, 4.09, maceration OR = 5.85, 95% CI: 3.40, 10.06) and change in BML volume (morphological deformity/extrusion OR = 2.17, 95% CI: 1.37, 3.45, maceration OR = 3.12, 95% CI: 1.87, 5.19). Only maceration was associated with baseline WOMAC knee pain (OR = 2.82, 95% CI: 1.79, 4.43) and prevalence of esKOA (OR = 7.53, 95% CI: 4.25, 13.31).
  
  
  
  Based on MRI, morphologic deformity/extrusion and maceration rather than intrameniscal signal or tear were associated with osteoarthritis severity and progression, which highlights the importance of differentiating distinct types of meniscal pathology.
authors.affiliation: Division of Rheumatology, Tufts Medical Center, Boston, USA; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: Benny.EathakkattuAntony@utas.edu.au.
authors.forename: B
authors.initials: B
authors.lastname: Antony
authors.affiliation: Division of Rheumatology, Tufts Medical Center, Boston, USA. Electronic address: jeffrey.driban@tufts.edu.
authors.forename: J B
authors.initials: JB
authors.lastname: Driban
authors.affiliation: The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA. Electronic address: lprice1@tuftsmedicalcenter.org.
authors.forename: L L
authors.initials: LL
authors.lastname: Price
authors.affiliation: Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, USA; Center for Innovations in Quality, Effectiveness and Safety Medical Care Line and Research Care Line; Michael E. DeBakey VAMC, Houston, TX, USA. Electronic address: ghlo@bcm.edu.
authors.forename: G H
authors.initials: GH
authors.lastname: Lo
authors.affiliation: Department of Radiology, Tufts Medical Center, Boston, USA. Electronic address: rward@tuftsmedicalcenter.org.
authors.forename: R J
authors.initials: RJ
authors.lastname: Ward
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, USA. Electronic address: MNevitt@psg.ucsf.edu.
authors.forename: M
authors.initials: M
authors.lastname: Nevitt
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, USA. Electronic address: JLynch@psg.ucsf.edu.
authors.forename: J
authors.initials: J
authors.lastname: Lynch
authors.affiliation: Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, RI, USA. Electronic address: Charles_Eaton@brown.edu.
authors.forename: C B
authors.initials: CB
authors.lastname: Eaton
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: Changhai.Ding@utas.edu.au.
authors.forename: C
authors.initials: C
authors.lastname: Ding
authors.affiliation: Division of Rheumatology, Tufts Medical Center, Boston, USA. Electronic address: tmcalindon@tuftsmedicalcenter.org.
authors.forename: T E
authors.initials: TE
authors.lastname: McAlindon
mesh_terms: D018771:Arthralgia / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D000072600:Meniscus / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Bone marrow lesions; End-stage knee osteoarthritis; Knee pain; Meniscus; Tear