Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 5/2019

Open Access 01-05-2019 | Osteoarthrosis | Musculoskeletal

Scrutinizing the cut-off for “pathological” meniscal body extrusion on knee MRI

Authors: F. Svensson, D. T. Felson, A. Turkiewicz, A. Guermazi, F. W. Roemer, P. Neuman, M. Englund

Published in: European Radiology | Issue 5/2019

Login to get access

Abstract

Objectives

Medial meniscal body extrusion ≥ 3 mm on MRI is often considered “pathologic.” The aims of this study were to (1) assess the adequacy of 3 mm as cut-off for “pathological” extrusion and (2) find an optimal cut-off for meniscal extrusion cross-sectionally associated with radiographic knee osteoarthritis, bone marrow lesions (BMLs), and cartilage damage.

Methods

Nine hundred fifty-eight persons, aged 50–90 years from Framingham, MA, USA, had readable 1.5 T MRI scans of the right knee for meniscal body extrusion (measured in mm). BMLs and cartilage damage were read using the whole organ magnetic resonance imaging score (WORMS). Knee X-rays were read according to the Kellgren and Lawrence (KL) scale. We evaluated the performance of the 3-mm cut-off with respect to the three outcomes and estimated a new cut-off maximizing the sum of sensitivity and specificity.

Results

The study persons had mean age of 62.2 years, 57.0% were women and the mean body mass index was 28.5 kg/m2. Knees with radiographic osteoarthritis, BMLs, and cartilage damage had overall more meniscal extrusion than knees without. The 3-mm cut-off had moderate sensitivity and low specificity for all three outcomes (sensitivity between 0.68 [95% CI 0.63–0.73] and 0.81 [0.73–0.87], specificity between 0.49 [0.45–0.52] and 0.54 [0.49–0.58]). Using 4 mm maximized the sum of sensitivity and specificity and improved the percentage of correctly classified subjects (from between 54 and 61% to between 64 and 79%).

Conclusions

The 4-mm cut-off may be used as an alternative cut-off for denoting pathological meniscal extrusion.

Key Points

• Medial meniscal body extrusion is strongly associated with osteoarthritis.
• The 3-mm cut-off for medial meniscal body extrusion has high sensitivity but low specificity with respect to bone marrow lesions, cartilage damage, and radiographic osteoarthritis.
• The 4-mm cut-off maximizes the sensitivity and specificity with respect to all three osteoarthritis features.
Literature
1.
Kenny C (1997) Radial displacement of the medial meniscus and Fairbank’s signs. Clin Orthop Relat Res (339):163–173
2.
Adams JG, McAlindon T, Dimasi M, Carey J, Eustace S (1999) Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis. Clin Radiol 54:502–506CrossRefPubMed
3.
Gale DR, Chaisson CE, Totterman SM, Schwartz RK, Gale ME, Felson D (1999) Meniscal subluxation: association with osteoarthritis and joint space narrowing. Osteoarthritis Cartilage 7:526–532CrossRefPubMed
4.
Sugita T, Kawamata T, Ohnuma M, Yoshizumi Y, Sato K (2001) Radial displacement of the medial meniscus in varus osteoarthritis of the knee. Clin Orthop Relat Res (387):171–177
5.
Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol 183:17–23CrossRefPubMed
6.
Englund M, Roos EM, Lohmander LS (2003) Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum 48:2178–2187CrossRefPubMed
7.
Englund M, Lohmander LS (2004) Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 50:2811–2819CrossRefPubMed
8.
Hunter DJ, Zhang YQ, Tu X et al (2006) Change in joint space width: hyaline articular cartilage loss or alteration in meniscus? Arthritis Rheum 54:2488–2495CrossRefPubMed
9.
Hunter DJ, Zhang YQ, Niu JB et al (2006) The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis. Arthritis Rheum 54:795–801CrossRefPubMed
10.
Englund M, Niu J, Guermazi A et al (2007) Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness. Arthritis Rheum 56:4048–4054CrossRefPubMed
11.
12.
13.
Englund M, Felson DT, Guermazi A et al (2011) Risk factors for medial meniscal pathology on knee MRI in older US adults: a multicentre prospective cohort study. Ann Rheum Dis 70:1733–1739CrossRefPubMed
14.
Choi CJ, Choi YJ, Lee JJ, Choi CH (2010) Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy 26:1602–1606CrossRefPubMed
15.
Crema MD, Roemer FW, Felson DT et al (2012) Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: the multicenter osteoarthritis study. Radiology 264:494–503CrossRefPubMedPubMedCentral
16.
Wirth W, Frobell RB, Souza RB et al (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 63:1162–1171CrossRefPubMed
17.
Wenger A, Englund M, Wirth W et al (2012) Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study. Eur Radiol 22:211–220CrossRefPubMed
18.
Bloecker K, Guermazi A, Wirth W et al (2013) Tibial coverage, meniscus position, size and damage in knees discordant for joint space narrowing - data from the osteoarthritis initiative. Osteoarthritis Cartilage 21:419–427CrossRefPubMed
19.
Guermazi A, Hayashi D, Jarraya M et al (2013) Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study. Radiology 268:814–821CrossRefPubMedPubMedCentral
20.
21.
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 67:206–211CrossRefPubMed
22.
Lynch JA, Roemer FW, Nevitt MC et al (2010) Comparison of BLOKS and WORMS scoring systems part I. Cross sectional comparison of methods to assess cartilage morphology, meniscal damage and bone marrow lesions on knee MRI: data from the osteoarthritis initiative. Osteoarthritis Cartilage 18:1393–1401CrossRefPubMedPubMedCentral
23.
Felson DT, Lynch J, Guermazi A et al (2010) Comparison of BLOKS and WORMS scoring systems part II. Longitudinal assessment of knee MRIs for osteoarthritis and suggested approach based on their performance: data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 18:1402–1407CrossRefPubMedPubMedCentral
24.
Hunter DJ, Guermazi A, Lo GH et al (2011) Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis Cartilage 19:990–1002CrossRefPubMedPubMedCentral
25.
Peterfy CG, Guermazi A, Zaim S et al (2004) Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 12:177–190CrossRefPubMed
26.
Englund M, Guermazi A, Roemer FW et al (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 60:831–839CrossRefPubMedPubMedCentral
27.
Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 33:569–574CrossRefPubMed
28.
Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF (1988) Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med 109:18–24CrossRefPubMed
29.
Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ (1992) Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med 116:535–539CrossRefPubMed
30.
Felson DT, Niu J, McClennan C et al (2007) Knee buckling: prevalence, risk factors, and associated limitations in function. Ann Intern Med 147:534–540CrossRefPubMed
31.
32.
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310CrossRefPubMed
33.
Guermazi A, Niu J, Hayashi D et al (2012) Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ 345:e5339CrossRefPubMedPubMedCentral
34.
Perkins NJ, Schisterman EF (2006) The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 163:670–675CrossRefPubMed
35.
Kuhn M, Johnson K (2013) Applied predictive modeling. Springer, New York, p 1 online resourceCrossRef
36.
StataCorp (2015) Stata statistical software: release 14. StataCorp LP, College Station
37.
38.
Metadata
Title
Scrutinizing the cut-off for “pathological” meniscal body extrusion on knee MRI
Authors
F. Svensson
D. T. Felson
A. Turkiewicz
A. Guermazi
F. W. Roemer
P. Neuman
M. Englund
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5914-0

Other articles of this Issue 5/2019

European Radiology 5/2019 Go to the issue

Gastrointestinal

Ability of DWI to characterize bowel fibrosis depends on the degree of bowel inflammation

Magnetic Resonance

Prediction of sorafenib treatment–related gene expression for hepatocellular carcinoma: preoperative MRI and histopathological correlation

Cardiac

Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves

Ultrasound

Quantitative ultrasound and machine learning for assessment of steatohepatitis in a rat model

Interventional

Volumetric 3D assessment of ablation zones after thermal ablation of colorectal liver metastases to improve prediction of local tumor progression

Neuro

Impact of guidelines for the management of minor head injury on the utilization and diagnostic yield of CT over two decades, using natural language processing in a large dataset