Background/Purpose: The meniscal root is a ligamentous structure that anchors the posterior horn of the meniscus to the tibial plateau. The association of isolated meniscal root tears with progression of osteoarthritis or cartilage loss has not been examined. Aim of the study was to assess the cross-sectional association of medial meniscal root tears with prevalent medial tibiofemoral cartilage damage and medial meniscal extrusion in subjects with radiographic osteoarthritis. We further wished to assess if isolated medial meniscal root tears increase the risk of incident and progressive cartilage damage in the medial tibiofemoral compartment at 30-month follow up.

Methods: The Multicenter Osteoarthritis (MOST) Study is a longitudinal observational study of subjects with or at risk for knee osteoarthritis. Knees were randomly selected from subjects with radiographic OA at baseline and read for presence of absence of root tear (κ=1 for intrareader agreement). Cartilage damage was graded from 0 to 6 in each of the 5 medial tibiofemoral subregions according to WORMS scoring system. Prevalent cartilage damage was defined as any score ≥2 in at least one subregion. Longitudinal progression of cartilage damage was studied for 548 patients who had follow up MRIs read, and was defined as at least within grade or more increase in at least one subregion including incident cartilage damage. Meniscal extrusion was recorded as present or absent. Isolated meniscal root tear was defined as the presence of a root tear without any additional meniscal damage (WORMS1-4). Knees were divided into 3 groups: knees with an isolated medial meniscal root tear (i.e., exposed group), those without root tears but with other meniscal damage (i.e., referent group A); and  knees without root tear or meniscal damage (i.e., referent group B). In the longitudinal analysis, we calculated relative risk (RR) of cartilage worsening comparing the exposed group and the group A with the group B.

Results: Of 594 knees included in the cross-sectional analysis (64.1% women, mean age 62.8 +/- 7.9, mean BMI 30.9 +/-5.2), 37 knees were in the exposed group, 293 in referent group A and 264 in referent group B. Exposed knees showed higher prevalence of meniscal extrusion than referent group B (91.9% vs. 60.7%, p<0.0001). Prevalence of cartilage damage was also higher in the exposed group than in group B (97.3% vs 63.7%, p<0.0001) but not group A (97.3% vs 95.2%, p=0.057). Of 548 knees included in the longitudinal analysis, 33 knees were in the exposed group, 270 in group A, and 245 in group B. The adjusted RRs of cartilage loss in the exposed group and the group A were 2.04 (95%CI 1.19 - 3.49) and 1.84 (95% CI 1.32 – 2.58), respectively, when compared with group B.

Conclusion: Knees with isolated medial meniscal root tears exhibit a higher prevalence of ipsicompartimental extrusion when compared to knees without meniscal damage. Isolated meniscal root tears increase the risk of ipsicompartmental cartilage loss longitudinally.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/medial-meniscal-root-tears-and-the-association-with-meniscal-extrusion-prevalent-cartilage-damage-and-longitudinal-cartilage-loss-the-most-study/