Background/Purpose:

Synovitis is a common feature in meniscal tear (MT) and osteoarthritis (OA). Synovitis has been associated with progression of cartilage damage in persons with OA, as has arthroscopic partial meniscectomy (APM), a frequent treatment for MT. It is unknown whether the presence or the persistence of effusion-synovitis is associated with changes in cartilage damage in patients with concurrent MT and OA.

Methods:

We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial of APM vs. physiotherapy (PT). Subjects were ≥45 years old, had MT on MRI, OA on MRI or radiograph, and knee symptoms. Subjects crossing-over between treatment groups or without both baseline and 18mo MRI were excluded. MRIs were read using the MRI OA Knee Score (MOAKS). Baseline effusion-synovitis was dichotomized as none/mild (0) and moderate/severe (1). Change in effusion-synovitis over 18mo was categorized as never developed (0 at baseline, 0 at 18mo), intermittent (1 at only 1 time point), and persistent (1 at baseline, 1 at 18mo). Change in cartilage damage over 18mo was examined in 14 subregions and assessed by a) number of subregions with worsening (subregions grade ≥1 at baseline with increased surface area affected by full thickness loss) and b) number of additional subregions affected (subregions grade 0 at baseline with new full thickness loss). Both outcomes were specified as binary (0 regions vs. 1+). We used logistic regression to investigate the associations between a) baseline effusion and b) change in effusion on both cartilage damage outcomes over 18mo in 4 individual models – with adjustment for differences in treatment (APM vs. PT), sex, BMI, and baseline cartilage damage.

Results:

We analyzed 174 knees (1/person), 102 had APM and 72 PT. Moderate/severe effusion was observed in 48% patients at baseline and 29% at 18mo. Fifty-six percent of subjects had subregions with worsening and 45% had additional subregions affected. Over 18mo, 44% subjects never developed effusion, 35% had intermittent effusion, and 21% had persistent effusion. Overall participants were 59% female, 58 years old, with a BMI of 30 kg/m². Compared to subjects who never developed effusion, those with intermittent effusion had 2.6-fold (95% CI 1.2, 5.5) greater odds of worsening cartilage damage, while those with persistent effusion had 4.5-fold (95% CI 1.6, 12.8) greater odds. Similar results were obtained for analyses of baseline effusion and number of additional subregions affected (Table).

Conclusion:

Effusion-synovitis status at baseline and 18mo was associated with worsening of cartilage damage at 18mo in patients with MT and OA, independent of study treatment. The risk of cartilage damage was greater in those with persistent effusion than in those with intermittent effusion. If confirmed in other studies, these findings would support research on the structural effects of interventions to reduce effusion in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-baseline-and-change-in-effusion-synovitis-on-cartilage-damage-over-18-months-in-patients-with-osteoarthritis-and-meniscal-tear/