The association of meniscal pathologic changes with cartilage loss in symptomatic knee ostoearthritis
The association of meniscal pathologic changes with cartilage loss in symptomatic knee ostoearthritis
复制标题
DOI：
10.1002/art.21724
复制
发表时间：
2006-03-01
影响因子：
--
通讯作者：
Felson, DT
中科院分区：
文献类型：
--
作者：
Hunter, DJ;Zhang, YQ;Felson, DT
Objective.探讨骨关节撕裂和骨关节错位作为有症状骨关节炎（OA）患者随后软骨丢失的危险因素的作用。研究受试者是波士顿膝关节骨关节炎研究中的症状性膝关节OA患者。基线评估包括膝关节磁共振成像（MRI）以及15个月和30个月时的随访MRI。使用半定量全器官磁共振成像评分，在内侧和外侧胫股关节的MRI上对腕关节和踝关节损伤进行评分。在每个胫股关节的所有5个板的MR图像上对胫股软骨进行评分，并使用eFilm Workstation软件测量胫骨位置。使用具有广义估计方程的比例优势逻辑回归模型来评估每个预测因子（每个模型中的关节位置因子和关节损伤作为二分预测因子）对隔室内5个板中的每个板的软骨损失的影响。模型根据年龄、体重指数（BMI）、胫骨宽度和性别进行调整。我们评估了257名受试者，其平均+/- SD年龄为66.6 +/- 9.2岁，BMI为31.5 +/- 5.7 kg/m2; 42%的受试者为女性，77%的膝关节X线片严重度≥ 2。在内侧胫道德关节，每一个测量的关节错位与软骨损失的风险增加。骨关节损伤和软骨损失之间也有很强的相关性。由于半脱位会导致髋臼覆盖和髋臼高度减少，因此覆盖减少和高度降低也会增加软骨丢失的风险。这项研究强调了症状性膝关节OA患者完整和功能性半月板的重要性，因为研究结果表明，这种功能的丧失对软骨损失具有重要影响。
Objective. To explore the role, of meniscal tears and meniscal malposition as risk factors for subsequent cartilage loss in subject,; with symptomatic osteoarthritis (OA).Methods. Study subjects were patients with symptomatic knee OA from the Boston Osteoarthritis of the Knee Study. Baseline assessments included knee magnetic resonance imaging (MRI) with followup MRI at 15 and 30 months. Cartilage and meniscal damage were scored on MRI in the medial and lateral tibiofemoral joints using the semiquantitative whole-organ magnetic resonance imaging score. Tibiofemoral cartilage was scored on MR images of all 5 plates of each tibiofemoral joint, and the meniscal position was measured using eFilm Workstation software. A proportional odds logistic regression model with generalized estimating equations was used to assess the effect of each predictor (meniscal position factor and meniscal damage as dichotomous predictors in each model) on cartilage loss in each of the 5 plates within a compartment. Models were adjusted for age, body mass index (BMI), tibial width, and sex.Results. We assessed 257 subjects whose mean +/- SD age was 66.6 +/- 9.2 years and BMI was 31.5 +/- 5.7 kg/m(2); 42% of subjects were female, and 77% of knees had a Kellgren/Lawrenice radiographic severity grade >= 2. In the medial tibioremoral joint, each measure of meniscal malposition was associated with an increased risk of cartilage loss. There was also a strong association between meniscal damage and cartilage loss. Since meniscal coverage and meniscal height diminished with subluxation, less coverage and reduced height also increased the risk of cartilage loss.Conclusion. This study highlights the importance of an intact and functioning meniscus in patients with symptomatic knee OA, since the findings demonstrate that loss of this function has important consequences for cartilage loss.