Abstract
To assess which structural abnormalities on knee MRI are associated with development of osteophytes in middle-aged subjects without radiographic knee osteoarthritis. We included subjects from the Osteoarthritis Initiative, aged 40-55 years, Kellgren & Lawrence grade 0 in both knees, and knee MRIs from both knees available at baseline, 24, 48 and 72 months. Structural exposures on MRI assessed using MOAKS included cartilage damage, bone marrow lesions, meniscal tear, meniscal extrusion, and Hoffa/effusion synovitis. We assessed whether each structural exposure was associated with the development of osteophytes on MRI in the medial and lateral tibiofemoral, and patellofemoral compartment. We estimated hazard ratios (HR) including 95% confidence intervals (CI) for osteophyte development using a mixed complementary log-log regression model adjusted for age, sex, and body mass index. We included 680 knees from 340 subjects with a mean (SD) age of 50 years (3.0), and 51% men. In the medial tibiofemoral compartment, the absolute risk of osteophyte development in the first 24-month period was 4% in knees without, and 15% in knees with medial meniscal tear. Corresponding adjusted HR was 6.6 (95%CI=3.4-12.9). In the lateral tibiofemoral compartment, the adjusted HR for developing osteophytes having a lateral meniscal tear was 3.3 (95%CI=1.3-8.4). In the patellofemoral compartment, patellofemoral cartilage damage was most clearly associated with developing osteophytes (HR=2.6, 95%CI=1.8-3.7). Meniscal tear seem to be the strongest structural risk factor for the development of tibiofemoral osteophytes, and patellofemoral cartilage damage for the development of patellofemoral osteophytes, respectively. Local biomechanical factors are important in early osteophyte development.
Highlights
The loss of articular cartilage is still considered the classic hallmark of osteoarthritis (OA), other structures within the knee joint, such as meniscus, subchondral bone, ligaments or synovium, are increasingly recognized as important1e3
It was recently suggested that the presence of medial tibia osteophytes on magnetic resonance imaging (MRI) was associated with medial meniscus extrusion and showed close associations with early stage knee OA6
Our study suggests that medial meniscal tears visible on MRI were most strongly associated with osteophyte development in the medial tibiofemoral compartment, and patellofemoral cartilage damage with development of osteophytes in the patellofemoral compartment
Summary
The loss of articular cartilage is still considered the classic hallmark of osteoarthritis (OA), other structures within the knee joint, such as meniscus, subchondral bone, ligaments or synovium, are increasingly recognized as important1e3. Meniscus damage and bone changes have recently been suggested to be important in the early stage of knee OA, often long before radiographic evidence of knee OA becomes apparent4e6. Meniscus damage is highly prevalent in middle-aged and elderly people in the general population and is typically present in knees with radiographic knee OA4,7. A previous population-based observational study using magnetic resonance imaging (MRI) reported that osteophytes were the most common structural feature noted among participants without radiographic OA, followed by cartilage lesions and bone marrow lesions (BMLs)[8]. Another study suggested that osteophytes, as well as cartilage lesions, were observed in all patients with early stage knee OA9. It was recently suggested that the presence of medial tibia osteophytes on MRI was associated with medial meniscus extrusion and showed close associations with early stage knee OA6
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