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Meniscal pathology on MRI increases the risk for both incident and enlarging subchondral bone marrow lesions of the knee: the MOST Study
  1. Martin Englund1,2,
  2. Ali Guermazi2,
  3. Frank W Roemer2,3,
  4. Mei Yang2,
  5. Yuqing Zhang2,
  6. Michael C Nevitt4,
  7. John A Lynch4,
  8. Cora E Lewis5,
  9. James Torner6,
  10. David T Felson2
  1. 1Lund University, Lund, Sweden
  2. 2Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Klinikum Augsburg, Augsburg, Germany
  4. 4University of California, San Francisco, California, USA
  5. 5University of Alabama, Birmingham, Alabama, USA
  6. 6University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Martin Englund, Musculoskeletal Sciences, Department of Orthopedics, Skåne University Hospital, Klinikgatan 22, SE-221 85 Lund, Sweden; martin.englund{at}


Objectives To investigate the association between meniscal pathology and incident or enlarging bone marrow lesions (BML) in knee osteoarthritis.

Methods The authors studied subjects from the Multicenter Osteoarthritis Study aged 50–79 years either with knee osteoarthritis or at high risk of the disease. Baseline and 30-months magnetic resonance images of knees (n=1344) were scored for subchondral BML. Outcome was defined as an increase in BML score in either the tibial or femoral condyle in medial and lateral compartments, respectively. The authors defined meniscal pathology at baseline as the presence of either meniscal lesions or meniscal extrusion. The risk of an increase in BML score in relation to meniscal status in the same compartment was estimated using a log linear regression model adjusted for age, sex, body mass index, physical activity level and mechanical axis. In secondary analyses the investigators stratified by ipsilateral tibiofemoral cartilage status at baseline and compartments with pre-existing BML.

Results The adjusted relative risk of incident or enlarging BML ranged from 1.8; 95% CI 1.3 to 2.3 for mild medial meniscal pathology to 5.0; 95% CI 3.2 to 7.7 for major lateral meniscal pathology (using no meniscal pathology in the same compartment as reference). Stratification by cartilage or BML status at baseline had essentially no effect on these estimates.

Conclusions Knee compartments with meniscal pathology have a substantially increased risk of incident or enlarging subchondral BML over 30 months. Higher relative risks were seen in those with more severe and with lateral meniscal pathology.

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  • Funding The Multicenter Osteoarthritis (MOST) Study is a cooperative epidemiological study of knee osteoarthritis funded by the National Institute on Aging (NIA): DTF – 1 U01 AG18820; JT – 1 U01 AG18832; CEL – 1 U01 AG18947; MCN – 1 U01 AG19069. ME was supported by the Arthritis Foundation.

  • Competing interests AG is president of Boston Imaging Core Lab, LLC (BICL), Boston, Massachusetts, USA, a company providing radiological image assessment services; and shareholder of Synarc Inc. FWR is vice president of BICL. None of the other authors have declared any conflict of interest.

  • Ethics approval This study was conducted with the approval of the Boston University Medical Center, H-22670.

  • Provenance and peer review Not commissioned; externally peer reviewed.