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

Autor: Katz JN; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Collins JE; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Brophy RH; Washington University School of Medicine, St. Louis, Missouri., Cole BJ; Rush Medical Center, Chicago, Illinois., Cox CL; Vanderbilt Medical Center, Nashville, Tennessee., Guermazi A; Boston Veteran's Medical Center and Boston University Medical Center, Boston, Massachusetts., Jones MH; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Levy BA; Mayo School of Medicine, Rochester, Minnesota., MacFarlane LA; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Mandl LA; Hospital for Special Surgery, New York, New York., Marx RG; Hospital for Special Surgery, New York, New York., Selzer F; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Spindler KP; Cleveland Clinic, Cleveland, Ohio., Wright RW; Vanderbilt Medical Center, Nashville, Tennessee., Losina E; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts., Chang Y; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Jazyk: angličtina
Zdroj: Arthritis care & research [Arthritis Care Res (Hoboken)] 2023 Jul 20. Date of Electronic Publication: 2023 Jul 20.
DOI: 10.1002/acr.25197
Abstrakt: Objective: Meniscal tear in persons aged ≥45 years is typically managed with physical therapy (PT), and arthroscopic partial meniscectomy (APM) is offered to those who do not respond. Prior studies suggest APM may be associated with greater progression of radiographic changes.
Methods: We assessed changes between baseline and 60 months in the Kellgren-Lawrence (KL) grade and OARSI radiographic score (including subscores for joint space narrowing and osteophytes) in subjects aged 45-85 years enrolled into a seven-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 a 60-month change in the OARSI score for subjects who underwent total knee replacement (TKR). In a sensitivity analysis, we classified subjects by randomization group.
Results: We analyzed data from 142 subjects (100 APM, 42 PT). The mean ± SD weighted baseline OARSI radiographic score was 3.8 ± 3.5 in the APM group and 4.0 ± 4.9 in the PT group. OARSI scores increased by a mean of 4.1 (95% confidence interval [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 the KL grade. Sensitivity analyses yielded similar findings to the primary analysis.
Conclusion: Subjects treated with APM had greater progression in the OARSI score because of osteophyte progression but not in the KL grade. The clinical implications of these findings require investigation.
(© 2023 American College of Rheumatology.)
Databáze: MEDLINE
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