Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees
Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees
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DOI：
10.1002/art.23462
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发表时间：
2008-06-01
影响因子：
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通讯作者：
Dunlop, Dorothy
中科院分区：
文献类型：
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作者：
Sharma, Leena;Eckstein, Felix;Dunlop, Dorothy
客观的。进行性膝骨关节炎（OA）被认为是局部因素作用于全身环境的结果。先前的研究尚未同时检查这些因素或比较定量和定性的软骨损失结果。本研究的目的是测试在控制其他因素后，半月板损伤、半月板挤压、排列不齐和松弛是否都能预测胫股软骨损失。方法。在基线时测量膝关节骨关节炎患者的松弛度和排列情况。磁共振成像包括用于半月板评分的自旋回波冠状和矢状成像以及用于软骨定量的水激发的轴向和冠状破坏梯度回波序列。胫骨和负重股骨髁软骨下骨区域和软骨表面被分割。对每个板中的软骨体积、裸露骨面积和软骨厚度进行量化，进展定义为软骨损失>每个板变异系数的2倍。定性结果被评估为软骨评分恶化。使用广义估计方程进行逻辑回归分析，得出每个因素的比值比，并调整年龄、性别、体重指数和其他因素。结果。我们研究了 153 人的 251 个膝盖。充分调整后，内侧半月板损伤预测内侧胫骨软骨体积减少和胫骨和股骨裸露骨增加，而内翻畸形预测内侧胫骨软骨体积和厚度减少以及胫骨和股骨裸露骨增加。横向半月板损伤预示着每一个横向结果。松弛和半月板挤压具有不一致的效果。经过充分调整，除了内侧松弛之外，没有任何因素可以预测定性结果。结论。使用定量软骨损失评估，独立预测胫骨和股骨损失的局部因素包括内侧半月板损伤和内翻排列不良（内侧）和外侧半月板损伤（外侧）。定量结果的测量在揭示这些关系方面比定性方法更敏感。
Objective. Progressive knee osteoarthritis (OA) is believed to result from local factors acting in a systemic environment. Previous studies have not examined these factors concomitantly or compared quantitative and qualitative cartilage loss outcomes. The aim of this study was to test whether meniscal damage, meniscal extrusion, malalignment, and laxity each predicted tibiofemoral cartilage loss after controlling for the other factors.Methods. Laxity and alignment were measured at baseline in individuals with knee OA. Magnetic resonance imaging included spin-echo coronal and sagittal imaging for meniscal scoring and axial and coronal spoiled gradient echo sequences with water excitation for cartilage quantification. Tibial and weight-bearing femoral condylar subchondral bone area and cartilage surface were segmented. Cartilage volume, denuded bone area, and cartilage thickness were quantified in each plate, with progression defined as cartilage loss >2 times the coefficient of variation for each plate. Qualitative outcome was assessed as worsening of the cartilage score. Logistic regression analysis with generalized estimating equations yielded odds ratios for each factor, adjusting for age, sex, body mass index, and the other factors.Results. We studied 251 knees in 153 persons. After full adjustment, medial meniscal damage predicted medial tibial cartilage volume loss and tibial and femoral denuded bone increase, while varus malalignment predicted medial tibial cartilage volume and thickness loss and tibial and femoral denuded bone increase. Lateral meniscal damage predicted every lateral outcome. Laxity and meniscal extrusion had inconsistent effects. After full adjustment, no factor except medial laxity predicted qualitative outcome.Conclusion. Using quantitative cartilage loss assessment, local factors that independently predicted tibial and femoral loss included medial meniscal damage and varus malalignment (medially) and lateral meniscal damage (laterally). A measurement of quantitative outcome was more sensitive at revealing these relationships than a qualitative approach.