Radiographic Changes Five Years After Treatment of Meniscal Tear and Osteoarthritic Changes

Abstract

ObjectiveMeniscal tear in persons aged 45+ years is typically managed with physical therapy (PT), with arthroscopic partial meniscectomy (APM) offered to those who do not respond. Prior studies suggest APM may be associated with greater progression of radiographic changes.MethodsWe assessed changes between baseline and 60 months in Kellgren‐Lawrence (KL) grade and OARSI radiographic score (including subscores for joint space narrowing and osteophytes) in subjects aged 45‐85 enrolled in a 7‐center randomized trial comparing outcomes of APM with PT for meniscal tear, osteoarthritis changes, and knee pain. The primary analysis classified subjects according to treatment received. To balance APM and PT groups, we developed a propensity score and used inverse probability weighting (IPW). We imputed 60‐month change in OARSI score for subjects who underwent total knee replacement (TKR). In a sensitivity analysis, we classified subjects by randomization group.ResultsWe analyzed data from 142 subjects (100 APM, 42 PT). Mean (SD) weighted baseline OARSI radiographic score was 3.8 (3.5) in the APM group, 4.0 (4.9) in the PT group. OARSI scores increased by a mean of 4.1 (95% CI 3.5‐4.7) in the APM group and 2.4 (95% CI 1.7‐3.2) in the PT group (p<0.001), due to changes in the osteophyte component. We did not observe statistically significant differences in KL grade. Sensitivity analyses yielded similar findings as the primary analysis.ConclusionsSubjects treated with APM had greater progression in OARSI Score due to osteophyte progression, but not in KL grade. The clinical implications of these findings require investigation.