gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2021)

26. - 29.10.2021, Berlin

Degeneration affects local meniscus extrusion

Meeting Abstract

  • presenting/speaker Andreas Martin Seitz - Institut für Unfallchirurgische Forschung und Biomechanik, Zentrum für Traumaforschung Ulm, Universitätsklinikum Ulm, Ulm, Germany
  • Sophie Dittberner - Institut für Unfallchirurgische Forschung und Biomechanik, Zentrum für Traumaforschung Ulm, Universitätsklinikum Ulm, Ulm, Germany
  • Kilian Stumpf - Experimental Cardiovascular Imaging, Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
  • Mirco Sgroi - Universitätsklinik Ulm, Ulm, Germany
  • Martin Faschingbauer - Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
  • Heiko Reichel - Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
  • Anita Ignatius - Institute of Orthopedic Research and Biomechanics, University of Ulm, Ulm, Germany
  • Lutz Dürselen - Institut für Unfallchirurgische Forschung und Biomechanik, Zentrum für Traumaforschung Ulm, Universitätsklinikum Ulm, Ulm, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2021). Berlin, 26.-29.10.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocAB84-142

doi: 10.3205/21dkou576, urn:nbn:de:0183-21dkou5768

Published: October 26, 2021

© 2021 Seitz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Magnetic Resonance Imaging (MRI) is the gold standard when investigating meniscus pathologies. Various authors indicated a direct correlation of load related meniscus extrusion (> 3mm) and radiographic osteoarthritis (OA). Further, it is known that the meniscus is a highly anisotropic and inhomogeneous tissue, which is even more pronounced with OA progression. Therefore, the aim of this study was to investigate possible local differences in meniscus extrusion when applying uniformed axial loads in mild and severe OA individuals.

Methods: 12 healthy volunteers and 12 osteoarthritic patients (Table 1 [Tab. 1]) were included in this prospective MRI study. Prior to image acquisition the individuals were placed in a customized MR compatible loading rig. Then, first an unloaded T1-weighted 3D-MRI sequence (3T Philips Achieva; TE 11.5ms; TE 21.2ms; acq.time 12 min) with a resolution of 0.2 x 0.2mm and a slice thickness of 0.4mm was used to investigate meniscal extrusion. After unloaded imaging was accomplished 25% bodyweight (BW) were applied following a previously described loading protocol. Image analysis was performed by an expert and comprised detailed segmentation of the meniscus in its three anatomical regions: pars anterior (PA), pars intermedia (PI) and pars posterior (PP) and repeatable measurement of meniscal extrusion in the respective areas. Non-parametric statistical analysis was carried out investigating differences in degeneration, anatomical regions and loading (SPSS). p=.05 was considered significant.

Results and Conclusion: Kruskal-Wallis testing resulted in significant different meniscus extrusion in all anatomical regions (medial and lateral, PA, PI, PP) for both volunteer and OA patient group in unloaded (p<.003) and 25% BW-loaded (p<.004) situations (Figure 1 [Fig. 1]). On the medial side the meniscus extrusion continuously decreased from anterior to posterior in both, volunteers and OA patients. Further, the extrusion of the medial menisci of the OA patients were significantly higher (p<.01), which is most likely due to the varus deformity of all OA patients. The extrusion level on the lateral side was much less, with no clear trends and below the threshold cut-off value of 3mm. Axial loading of 25% BW had only a minor effect on meniscus extrusion, indicating that this external load application is not mandatory to detect pathological meniscal extrusion.

This is the first in-vivo study which successfully showed the impact of axial loading and knee joint degeneration on regional differences in meniscal extrusion. The findings of the present study can help to further elucidate the interplay between knee joint OA and meniscus degeneration.