Knee Ligament & Joint ReplacementLarge Knee Swelling may be a Reason to Operate

Association of Changes in Effusion‐Synovitis and Progression of Cartilage Damage Over 18 Months in Patients with Osteoarthritis and Meniscal Tear

Lindsey A. MacFarlane Heidi Yang Jamie E. Collins Mohamed Jarraya Ali Guermazi Lisa A. Mandl Scott D. Martin John Wright Elena Losina

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First published: 22 August 2018 https://doi.org/10.1002/art.40660

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/art.40660

Abstract

Objective

Synovitis is a feature of knee osteoarthritis (OA) and meniscal tear and has been associated with articular cartilage damage. Our study examined the associations between baseline and changes in effusion‐synovitis and changes in cartilage damage in a cohort with OA and meniscal tear.

Methods

We analyzed data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of surgery vs. physical therapy for treatment of meniscal tear. We performed semiquantitative grading of effusion‐synovitis and cartilage damage on magnetic resonance imaging (MRI), and dichotomized effusion‐synovitis as none/small (‘minimal’) and medium/large (‘extensive’). We assessed the association between baseline and changes in effusion‐synovitis on changes in cartilage damage size and depth over 18 months, using Poisson regression models. Analyses were adjusted for demographics, treatment, and baseline cartilage damage.

Results

We analyzed 221 participants. Over 18 months, effusion‐synovitis was persistently minimal in 45.3% and persistently extensive in 21.3%. The remaining 33.5% had minimal synovitis on one occasion and extensive on the other. In adjusted analyses, extensive effusion‐synovitis at baseline was associated with a relative risk (RR) of 1.7 (95% CI 1.1, 2.6) for progression of cartilage damage depth. Compared to those with persistently minimal effusion‐synovitis, persistently extensive effusion‐synovitis had a statistically significant increased risk of progression of cartilage damage depth (RR 2.0 95% CI 1.1, 3.4).

Conclusions

The presence of extensive effusion‐synovitis is associated with subsequent progression of cartilage damage over 18 months. Persistence of extensive effusion‐synovitis over time was associated with the greatest risk of concurrent cartilage damage progression.

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Chatenya Chauhan FRCSEd (Trauma & Orthopaedics)

Mr Chauhan has been a consultant in trauma and orthopaedic surgery since 2002 with a focus on trauma, arthroscopic and joint replacement work mainly around the lower limb. He graduated from Dundee University & lectured in Sheffield University in Anatomy and Physiology. After completing basic surgical training there, Orthopaedic training commenced in Leeds followed by a fellowship at the Royal Orthopaedic Hospital in Birmingham. Arthroscopy and cartilage research was undertaken at Smith and Nephew’s Research Facility in York and University College London helped to validate the early imaging of cartilage and establish an arthroscopic service in Southend-on-Sea where he was appointed as a Consultant. During the time there he has developed minimally invasive approach to anterior cruciate ligament reconstruction making it possible to use a novel approach to hamstring ligament harvesting. Research interests included developing methods of treatment for cartilage damage. Mr. Chauhan is described as a caring individual with his approach to patients and their needs using great attention to detail. These are qualities that keep patients giving the highest recommendation and are also seen in the approach to individualised teaching of Foundation, Core and Speciality Trainees as well as General Practitioner colleagues.

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