The association between meniscal body extrusion and the development/enlargement of bone marrow lesions on knee MRI in overweight and obese women

Fan Zhang; Sita M Bierma-Zeinstra; Edwin H G Oei; Aleksandra Turkiewicz; Martin Englund; Jos Runhaar

doi:10.1016/j.ocarto.2019.100015

The association between meniscal body extrusion and the development/enlargement of bone marrow lesions on knee MRI in overweight and obese women

Osteoarthr Cartil Open. 2019 Nov 27;1(3-4):100015. doi: 10.1016/j.ocarto.2019.100015. eCollection 2020 Jan-Feb.

Authors

Fan Zhang¹, Sita M Bierma-Zeinstra^{2

3}, Edwin H G Oei⁴, Aleksandra Turkiewicz¹, Martin Englund^{1

5}, Jos Runhaar³

Affiliations

¹ Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden.
² Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
³ Department of General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands.
⁴ Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, the Netherlands.
⁵ Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA.

Abstract

Objective: To determine the association between meniscal body extrusion and bone marrow lesion (BML) development/enlargement in overweight and obese women at high risk of knee osteoarthritis (OA).

Design: We used baseline and 30 months follow-up data of the PROOF study, Netherlands, comprising overweight or obese women aged 50-60 years, free of clinical knee OA. All subjects (n = 395) completed a questionnaire on knee complaints and physical activity, underwent physical examination, radiography, and repeated 1.5 T MRI of both knees. Using the mid-coronal MRI slice, one observer measured tibial plateau width and meniscal body extrusion of both menisci in both knees. BMLs and meniscal damage were read using the semi-quantitative MOAKS scoring system by another observer. The association between BML development and meniscal extrusion was primarily analyzed with a random-effects logistic regression model adjusted for age, body weight, body height, physical activity, meniscus damage, knee alignment, and tibia width. In addition, we used a fixed-effect regression model for evaluation of knee-specific factors.

Results: In our primary model, there was about 24% increased risk of BML incidence/enlargement per 1 mm extrusion (95% confidence interval [CI] 0.99, 1.57) for medial compartments and 69% risk increase (95% confidence interval [CI] 1.27, 2.25) for the lateral compartments. Results from the fixed-effects regression model were similar, strengthening the validity of the findings.

Conclusions: Meniscal body extrusion is an important factor influencing BML development/enlargement, and thus may be a potential treatment target in knee OA development.

Keywords: Bone marrow lesions; Meniscal extrusion; Overweight women.