Top

Published in:

01-01-2012 | Magnetic Resonance

Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study

Authors: Andrea Wenger, Martin Englund, Wolfgang Wirth, Martin Hudelmaier, Kent Kwoh, Felix Eckstein, for the OAI Investigators

Published in: European Radiology | Issue 1/2012

Abstract

Objectives

To explore whether quantitative, three-dimensional measurements of meniscal position and size are associated with knee pain using a within-person, between-knee study design.

Methods

We studied 53 subjects (19 men, 34 women) from the Osteoarthritis Initiative, with identical radiographic OA grades in both knees, but frequent pain in one and no pain in the other knee. The tibial plateau and menisci were analyzed using coronally reconstructed double echo steady-state sequence with water excitation (DESSwe) MRI.

Results

The medial meniscus covered a smaller proportion of the tibial plateau (−5%) and displayed greater extrusion of the body (+15%) in painful than in painless knees (paired t-test; p < 0.05). The external margin of the lateral meniscus showed greater extrusion of the body in painful knees (+22%; p = 0.03), but no significant difference in the position of its internal margin or tibial coverage. Medial or lateral extrusion ≥3 mm was more frequent in painful (n = 23) than in painless knees (n = 12; McNemar’s test; p = 0.02). No significant association was observed between meniscal size and knee pain.

Conclusions

These data suggest a relationship between extrusion of the meniscal body, as measured with quantitative MRI, and knee pain in subjects with knee OA. Further studies need to confirm these findings and their clinical relevance.

Key Points

Meniscal segmentation provides quantitative measures of meniscal size/position
Between-knee, within-person approaches can explore potential sources of knee pain
Meniscal extrusion may be a potential source of knee pain

Englund M, Guermazi A, Lohmander SL (2009) The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin North Am 47(4):703–712PubMedCrossRef

Rannou F, Sellam J, Berenbaum F (2010) Pathophysiology of osteoarthritis: updated concepts. Presse Med 39(11):1159–1163PubMedCrossRef

Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359(11):1108–1115PubMedCrossRef

McNicholas MJ, Rowley DI, McGurty D, Adalberth T, Abdon P, Lindstrand A, Lohmander LS (2000) Total meniscectomy in adolescence. A thirty-year follow-up. J Bone Joint Surg Br 82(2):217–221PubMedCrossRef

Englund M, Guermazi A, Roemer FW, Aliabadi P, Yang M, Lewis CE, Torner J, Nevitt MC, Sack B, Felson DT (2009) Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study. Arthritis Rheum 60(3):831–839PubMedCrossRef

Englund M, Lohmander LS (2004) Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 50(9):2811–2819PubMedCrossRef

Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B(4):664–670PubMed

Roos H, Adalberth T, Dahlberg L, Lohmander LS (1995) Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthr Cartil 3(4):261–267PubMedCrossRef

Hunter DJ, Zhang YQ, Niu JB, Tu X, Amin S, Clancy M, Guermazi A, Grigorian M, Gale D, Felson DT (2006) The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis. Arthritis Rheum 54(3):795–801PubMedCrossRef

10.

Sharma L, Eckstein F, Song J, Guermazi A, Prasad P, Kapoor D, Cahue S, Marshall M, Hudelmaier M, Dunlop D (2008) Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees. Arthritis Rheum 58(6):1716–1726PubMedCrossRef

11.

Chang A, Moisio K, Chmiel JS, Eckstein F, Guermazi A, Almagor O, Cahue S, Wirth W, Prasad P, Sharma L (2011) Subregional effects of meniscal tears on cartilage loss over 2 years in knee osteoarthritis. Ann Rheum Dis 70(1):74–79PubMedCrossRef

12.

Rennie WJ, Finlay DB (2006) Meniscal extrusion in young athletes: associated knee joint abnormalities. AJR Am J Roentgenol 186(3):791–794PubMedCrossRef

13.

Choi CJ, Choi YJ, Lee JJ, Choi CH (2010) Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy 26(12):1602–1606PubMedCrossRef

14.

Lee DH, Lee BS, Kim JM, Yang KS, Cha EJ, Park JH, Bin SI (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19(2):222–229PubMedCrossRef

15.

Puig L, Monllau JC, Corrales M, Pelfort X, Melendo E, Caceres E (2006) Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings. Knee Surg Sports Traumatol Arthrosc 14(4):394–398PubMedCrossRef

16.

Englund M, Niu J, Guermazi A, Roemer FW, Hunter DJ, Lynch JA, Lewis CE, Torner J, Nevitt MC, Zhang YQ, Felson DT (2007) Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness. Arthritis Rheum 56(12):4048–4054PubMedCrossRef

17.

Bhattacharyya T, Gale D, Dewire P, Totterman S, Gale ME, McLaughlin S, Einhorn TA, Felson DT (2003) The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am 85-A(1):4–9PubMed

18.

Torres L, Dunlop DD, Peterfy C, Guermazi A, Prasad P, Hayes KW, Song J, Cahue S, Chang A, Marshall M, Sharma L (2006) The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthr Cartil 14(10):1033–1040PubMedCrossRef

19.

Conaghan PG, Felson DT (2004) Structural associations of osteoarthritis pain: lessons from magnetic resonance imaging. Novartis Found Symp 260:191–201PubMedCrossRef

20.

Kornaat PR, Bloem JL, Ceulemans RY, Riyazi N, Rosendaal FR, Nelissen RG, Carter WO, Hellio Le Graverand MP, Kloppenburg M (2006) Osteoarthritis of the knee: association between clinical features and MR imaging findings. Radiology 239(3):811–817PubMedCrossRef

21.

Heppelmann B (1997) Anatomy and histology of joint innervation. J Peripher Nerv Syst 2(1):5–16PubMed

22.

Dye SF, Vaupel GL, Dye CC (1998) Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia. Am J Sports Med 26(6):773–777PubMed

23.

Mine T, Kimura M, Sakka A, Kawai S (2000) Innervation of nociceptors in the menisci of the knee joint: an immunohistochemical study. Arch Orthop Trauma Surg 120(3–4):201–204PubMedCrossRef

24.

Neogi T, Felson D, Niu J, Nevitt M, Lewis CE, Aliabadi P, Sack B, Torner J, Bradley L, Zhang Y (2009) Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ 339:b2844. doi:10.1136/bmj.b2844.:b2844 PubMedCrossRef

25.

Eckstein F, Benichou O, Wirth W, Nelson DR, Maschek S, Hudelmaier M, Kwoh K, Guermazi A, Hunter D, for the OAI investigators (2009) Direct comparison of cartilage loss in painful contra-lateral knees with and without joint space narrowing - data from the Osteoarthritis Initiative (OAI). Arthritis Care Res 61(9):1218–1225CrossRef

26.

Swanson MS, Prescott JW, Best TM, Powell K, Jackson RD, Haq F, Gurcan MN (2010) Semi-automated segmentation to assess the lateral meniscus in normal and osteoarthritic knees. Osteoarthr Cartil 18(3):344–353PubMedCrossRef

27.

Bowers ME, Tung GA, Fleming BC, Crisco JJ, Rey J (2007) Quantification of meniscal volume by segmentation of 3T magnetic resonance images. J Biomech 40(12):2811–2815PubMedCrossRef

28.

Elsner JJ, Portnoy S, Guilak F, Shterling A, Linder-Ganz E (2010) MRI-based characterization of bone anatomy in the human knee for size matching of a medial meniscal implant. J Biomech Eng 132(10):101008PubMedCrossRef

29.

Wirth W, Frobell RB, Souza RB, Li X, Wyman BT, Le Graverand MP, Link TM, Majumdar S, Eckstein F (2010) A three-dimensional quantitative method to measure meniscus shape, position, and signal intensity using MR images: a pilot study and preliminary results in knee osteoarthritis. Magn Reson Med 63(5):1162–1171PubMedCrossRef

30.

Nevitt MC, Peterfy C, Guermazi A, Felson DT, Duryea J, Woodworth T, Chen H, Kwoh K, Harris TB (2007) Longitudinal performance evaluation and validation of fixed-flexion radiography of the knee for detection of joint space loss. Arthritis Rheum 56(5):1512–1520PubMedCrossRef

31.

Altman RD, Gold GE (2007) Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 15(Suppl A):1–56CrossRef

32.

Spector TD, Hart DJ, Byrne J, Harris PA, Dacre JE, Doyle DV (1993) Definition of osteoarthritis of the knee for epidemiological studies. Ann Rheum Dis 52(11):790–794PubMedCrossRef

33.

Peterfy CG, Schneider E, Nevitt M (2008) The osteoarthritis initiative: report on the design rationale for the magnetic resonance imaging protocol for the knee. Osteoarthr Cartil 16(12):1433–1441PubMedCrossRef

34.

Schneider E, NessAiver M, White D, Purdy D, Martin L, Fanella L, Davis D, Vignone M, Wu G, Gullapalli R (2008) The osteoarthritis initiative (OAI) magnetic resonance imaging quality assurance methods and results. Osteoarthr Cartil 16(9):994–1004PubMedCrossRef

35.

Eckstein F, Hudelmaier M, Wirth W, Kiefer B, Jackson R, Yu J, Eaton CB, Schneider E (2006) Double echo steady state magnetic resonance imaging of knee articular cartilage at 3 Tesla: a pilot study for the Osteoarthritis Initiative. Ann Rheum Dis 65(4):433–441PubMedCrossRef

36.

Wirth W, Nevitt M, Hellio Le Graverand MP, Benichou O, Dreher D, Davies RY, Lee J, Picha K, Gimona A, Maschek S, Hudelmaier M, Eckstein F (2010) Sensitivity to change of cartilage morphometry using coronal FLASH, sagittal DESS, and coronal MPR DESS protocols–comparative data from the Osteoarthritis Initiative (OAI). Osteoarthr Cartil 18(4):547–554PubMedCrossRef

37.

Crues JV III, Mink J, Levy TL, Lotysch M, Stoller DW (1987) Meniscal tears of the knee: accuracy of MR imaging. Radiology 164(2):445–448PubMed

38.

Burgkart R, Eckstein F, Sittek H, Schittich I, Träger J, Hipp E (1995) Schnittanatomie des Kniegelenks - Korrelation von anatomischen Präparat, Computertomograhie und Magnetresonanztomographie, Schwerpunkt:hinteres Kreuzband und mediales Kompartiment. Sportorthopädie - Sporttraumatologie 11(4):262–267

39.

Burgkart R, Schelter R, Eckstein F, Rechl H, Träger J (1995) Schnittanatomie des Kniegelenks - Korrelation von anatomischen Präparat, Computertomograhie und Magnetresonanztomographie, Schwerpunkt:posterolaterale Knieregion. Sportorthopädie - Sporttraumatologie 11(2):112–117

40.

Eckstein F, Ateshian G, Burgkart R, Burstein D, Cicuttini F, Dardzinski B, Gray M, Link TM, Majumdar S, Mosher T, Peterfy C, Totterman S, Waterton J, Winalski CS, Felson D (2006) Proposal for a nomenclature for magnetic resonance imaging based measures of articular cartilage in osteoarthritis. Osteoarthr Cartil 14(10):974–983PubMedCrossRef

41.

Glüer CC, Blake G, Lu Y, Blunt BA, Jergas M, Genant HK (1995) Accurate assessment of precision errors: how to measure the reproducibility of bone densitometry techniques. Osteoporos Int 5(4):262–270PubMedCrossRef

42.

Burgkart R, Glaser C, Hyhlik-Durr A, Englmeier KH, Reiser M, Eckstein F (2001) Magnetic resonance imaging-based assessment of cartilage loss in severe osteoarthritis: accuracy, precision, and diagnostic value. Arthritis Rheum 44(9):2072–2077PubMedCrossRef

43.

Graichen H, Eisenhart-Rothe R, Vogl T, Englmeier KH, Eckstein F (2004) Quantitative assessment of cartilage status in osteoarthritis by quantitative magnetic resonance imaging: technical validation for use in analysis of cartilage volume and further morphologic parameters. Arthritis Rheum 50(3):811–816PubMedCrossRef

44.

Roemer FW, Zhang Y, Niu J, Lynch JA, Crema MD, Marra MD, Nevitt MC, Felson DT, Hughes LB, El-Khoury GY, Englund M, Guermazi A (2009) Tibiofemoral joint osteoarthritis: risk factors for MR-depicted fast cartilage loss over a 30-month period in the multicenter osteoarthritis study. Radiology 252(3):772–780PubMedCrossRef

45.

Guermazi A, Burstein D, Conaghan P, Eckstein F, Hellio Le Graverand-Gastineau MP, Keen H, Roemer FW (2008) Imaging in osteoarthritis. Rheum Dis Clin North Am 34(3):645–687PubMedCrossRef

46.

Frobell RB, Souza RB, Wyman BT, Wirth W., Hellio-Le Graverand MP, Hudelmaier M., Li X, Link T, Eckstein F, Majumdar S (2009) Mensicus shape, position, and signal under simulated weightbearing and non-weightbearing conditions in vivo. Osteorthritis and Cartilage, OARSI 17 Supple 1, Abstract:S236

47.

Cotofana S, Eckstein F, Wirth W, Souza RB, Li X, Wyman B, Hellio-Le Graverand MP, Link T, Majumdar S (2011) In vivo measures of cartilage deformation: patterns in healthy and osteoarthritic female knees using 3T MR imaging. Eur Radiol 21(6):1127–1135PubMedCrossRef

48.

Peterfy CG, Guermazi A, Zaim S, Tirman PF, Miaux Y, White D, Kothari M, Lu Y, Fye K, Zhao S, Genant HK (2004) Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthr Cartil 12(3):177–190PubMedCrossRef

49.

Hunter DJ, Lo GH, Gale D, Grainger AJ, Guermazi A, Conaghan PG (2008) The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston Leeds Osteoarthritis Knee Score). Ann Rheum Dis 67(2):206–211PubMedCrossRef

50.

Englund M, Guermazi A, Roemer FW, Yang M, Zhang Y, Nevitt MC, Lynch JA, Lewis CE, Torner J, Felson DT (2010) Meniscal pathology on MRI increases the risk for both incident and enlarging subchondral bone marrow lesions of the knee: the MOST Study. Ann Rheum Dis 69(10):1796–1802PubMedCrossRef

51.

Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, Kazis L, Gale DR (2001) The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med 134(7):541–549PubMed

52.

Felson DT, Niu J, Guermazi A, Roemer F, Aliabadi P, Clancy M, Torner J, Lewis CE, Nevitt MC (2007) Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging. Arthritis Rheum 56(9):2986–2992PubMedCrossRef

53.

Boxheimer L, Lutz AM, Zanetti M, Treiber K, Labler L, Marincek B, Weishaupt D (2006) Characteristics of displaceable and nondisplaceable meniscal tears at kinematic MR imaging of the knee. Radiology 238(1):221–231PubMedCrossRef

Title: Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study
Authors: Andrea Wenger
Martin Englund
Wolfgang Wirth
Martin Hudelmaier
Kent Kwoh
Felix Eckstein
for the OAI Investigators
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: European Radiology / Issue 1/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-011-2234-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 1/2012

Hepatic and pancreatic involvement in hereditary hemorrhagic telangiectasia: quantitative and qualitative evaluation with 64-section CT in asymptomatic adult patients

Targeted dual-energy single-source CT for characterisation of urinary calculi: experimental and clinical experience

High-resolution spiral CT of the breast at very low dose: concept and feasibility considerations

Cell tracking in cardiac repair: what to image and how to image

The relationship between lung function impairment and quantitative computed tomography in chronic obstructive pulmonary disease

Implementation of an anonymisation tool for clinical trials using a clinical trial processor integrated with an existing trial patient data information system