To assess the presence of early degenerative changes on Magnetic Resonance Imaging (MRI) 24 months after a traumatic meniscal tear and to compare these changes in patients treated with arthroscopic partial meniscectomy or physical therapy plus optional delayed arthroscopic partial meniscectomy. We included patients aged 18–45 years with a recent onset, traumatic, MRI verified, isolated meniscal tear without radiographic osteoarthritis. Patients were randomized to arthroscopic partial meniscectomy or standardized physical therapy with optional delayed arthroscopic partial meniscectomy. MRIs at baseline and 24 months were scored using the MRI Osteoarthritis Knee Score (MOAKS). We compared baseline MRIs to healthy controls aged 18–40 years. The outcome was the progression of bone marrow lesions (BMLs), cartilage defects and osteophytes after 24 months in patients. We included 99 patients and 50 controls. At baseline, grade 2 and 3 BMLs were present in 26% of the patients (n = 26), compared to 2% of the controls (n = 1) (between group difference 24% (95% CI 15% to 34%)). In patients, 35% (n = 35) had one or more cartilage defects grade 1 or higher, compared to 2% of controls (n = 1) (between group difference 33% (95% CI 23% to 44%)). At 24 months MRI was available for 40 patients randomized to arthroscopic partial meniscectomy and 41 patients randomized to physical therapy. At 24 months 30% (n = 12) of the patients randomized to arthroscopic partial meniscectomy showed BML worsening, compared to 22% (n = 9) of the patients randomized to physical therapy (between group difference 8% (95% CI −11% to 27%)). Worsening of cartilage defects was present in 40% (n = 16) of the arthroscopic partial meniscectomy group, compared to 22% (n = 9) of the physical therapy group (between group difference 18% (95% CI −2% to 38%)). Of the patients who had no cartilage defect at baseline, 33% of the arthroscopic partial meniscectomy group had a new cartilage defect at follow-up compared to 14% of the physical therapy group. Osteophyte worsening was present in 18% (n = 7) of the arthroscopic partial meniscectomy group and 15% (n = 6) of the physical therapy group (between group difference 3% (95% CI −13% to 19%)). Our results might suggest more worsening of BMLs and cartilage defects with arthroscopic partial meniscectomy compared to physical therapy with optional delayed arthroscopic partial meniscectomy at 24-month follow-up in young patients with isolated traumatic meniscal tears without radiographic OA.

中文翻译：

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基线时和创伤性半月板损伤后 2 年的膝关节创伤后和 OA 相关病变：随机对照试验的二次分析

旨在评估创伤性半月板撕裂 24 个月后磁共振成像 (MRI) 是否存在早期退行性变化，并比较接受关节镜部分半月板切除术或物理治疗加可选延迟关节镜部分半月板切除术治疗的患者的这些变化。我们纳入的患者年龄为 18-45 岁，近期发病、外伤、经 MRI 证实、孤立性半月板撕裂，无放射学骨关节炎。患者被随机分配接受关节镜部分半月板切除术或标准化物理治疗，并可选择延迟关节镜部分半月板切除术。使用 MRI 骨关节炎膝关节评分 (MOAKS) 对基线和 24 个月的 MRI 进行评分。我们将基线 MRI 与 18-40 岁的健康对照进行了比较。结果是患者 24 个月后骨髓病变 (BML)、软骨缺损和骨赘的进展情况。我们纳入了 99 名患者和 50 名对照者。基线时，26% 的患者 (n = 26) 存在 2 级和 3 级 BML，而对照组 (n = 1) 的比例为 2%（组间差异 24%（95% CI 15% 至 34%） ）。在患者中，35% (n = 35) 患有一种或多种 1 级或以上软骨缺损，而对照组 (n = 1) 的这一比例为 2%（组间差异为 33%（95% CI 23% 至 44%））。 24 个月时，40 名患者随机接受关节镜部分半月板切除术，41 名患者随机接受物理治疗。 24 个月时，30% (n = 12) 随机接受关节镜部分半月板切除术的患者显示 BML 恶化，而随机接受物理治疗的患者中有 22% (n = 9) 表现出 BML 恶化（组间差异 8% (95% CI -11 % 至 27%))。关节镜部分半月板切除术组中有 40% (n = 16) 出现软骨缺损恶化，而物理治疗组中有 22% (n = 9) 出现软骨缺损恶化（组间差异 18% (95% CI -2% to 38) %））。在基线时没有软骨缺损的患者中，关节镜部分半月板切除术组中 33% 的患者在随访时出现新的软骨缺损，而物理治疗组中这一比例为 14%。关节镜半月板部分切除术组中有 18% (n = 7) 出现骨赘恶化，物理治疗组中有 15% (n = 6) 有骨赘恶化（组间差异为 3% (95% CI -13% 至 19%)）。我们的结果可能表明，对于患有孤立性外伤性半月​​板撕裂且无放射学 OA 的年轻患者，在 24 个月的随访中，与可选的延迟关节镜部分半月板切除术的物理治疗相比，关节镜下部分半月板切除术的 BML 和软骨缺损更严重。