Influence of Baseline Magnetic Resonance Imaging Features on Outcome of Arthroscopic Meniscectomy and Physical Therapy Treatment of Meniscal Tears in Osteoarthritis
| Autor: | Lisa A. Mandl, Michael J. Stuart, Jeffrey N. Katz, Mathew Matava, Jamie E. Collins, Elena Losina, Morgan H Jones, Brian J. Cole, Amelia R. Winter, Scot T. Martin, Bruce A. Levy, Robert H. Brophy, Kurt P. Spindler, Rick Wright, Clare E. Safran-Norton, Lindsey A MacFarlane, Heidi Yang, Robert G Marx, Ali Guermazi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Arthroscopic meniscectomy medicine.medical_specialty Pain Meniscal tears Physical Therapy Sports Therapy and Rehabilitation Osteoarthritis Meniscus (anatomy) Article Cohort Studies Arthroscopy 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Physical Therapy Modalities Aged Meniscectomy 030203 arthritis & rheumatology 030222 orthopedics medicine.diagnostic_test business.industry Magnetic resonance imaging Middle Aged Osteoarthritis Knee medicine.disease Magnetic Resonance Imaging Tibial Meniscus Injuries Treatment Outcome medicine.anatomical_structure Female Radiology business |
| Popis: | BACKGROUND: Arthroscopic partial meniscectomy (APM) is used to treat meniscal tears, though its efficacy is controversial. PURPOSE: This study used magnetic resonance imaging (MRI) to determine characteristics that lead to greater benefit from APM and physiotherapy (PT) than from PT alone among patients with meniscal tear and knee osteoarthritis (OA). STUDY DESIGN: Secondary analysis of data from a randomized clinical trial. METHODS: Using data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, we first assessed whether the effect of treatment on pain scores at 6 months differed according to baseline MRI features (bone marrow lesions, cartilage and meniscal damage). Second, we summed MRI features associated with differential pain relief between APM and PT to create a ‘Damage Score’. The Damage Score included BML number and cartilage damage size with possible values of 0 (least damage), 1 and 2 (greatest damage). We used linear models to determine whether the association between Damage Score and pain relief at 6 months differed for APM vs. PT. RESULTS: We included 220 participants; 13% had the least damage, 52% moderate damage, and 34% greatest damage. Though treatment type did not significantly modify the association of Damage Score and change in pain (p interaction=0.13), those with least and moderate damage had greater improvement in KOOS Pain with APM than with PT, by 15 and 7 points respectively. Those with greatest damage had similar improvement with APM and PT. CONCLUSION: In patients with OA and meniscal tear, those with less intra-articular damage on MRI may have greater improvement in pain with APM and PT than with PT alone. However, these results should be interpreted cautiously due to limited sample size. WHAT IS KNOWN: Several studies of patients with mild to moderate OA did not document a statistically or clinically significant difference in pain relief between APM and physiotherapy for the treatment of meniscal tear. WHAT THIS STUDY ADDS: We use magnetic resonance imaging to predict treatment outcomes in operative and non-operative treatment of meniscal tear in patients with knee osteoarthritis. We identify of a subgroup of patients with less intra-articular damage that have greater improvement in pain with operative than non-operative management of meniscal tear |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|