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Medial compartment defects progress at a more rapid rate than lateral cartilage defects in older adults with minimal to moderate knee osteoarthritis (OA): data from the OA initiative

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine: (1) rates and risk factors for progression of lateral and medial full-thickness cartilage defect size in older adults without severe knee osteoarthritis (OA), and (2) whether risk factors for defect progression differ for knees with Kellgren–Lawrence OA grade 3 (moderate) OA versus grades 0–2 (none to mild) OA.

Methods

Three-hundred and eighty adults enrolled in the Osteoarthritis Initiative were included (43% male, mean age 63.0 SD 9.2 years). Ethical approval was obtained at all study sites prior to enrollment. All participants had full-thickness tibial or weight-bearing femoral condylar cartilage defects on baseline knee MRIs. Baseline OA grade was KL grade 3 in 71.3% and grades 0–2 in 21.7% of participants. Repeat MRIs were obtained at a minimum 2-year follow-up. Independent risk of progression in defect size due to demographic factors, knee alignment, OA grade, knee injury and surgery history, and baseline knee symptoms was determined by multivariate Cox proportional hazards and linear regression modeling.

Results

The average increase in defect size over 2 years for lateral defects was 0.18 cm2 (SD 0.60) and for medial defects was 0.49 cm2 (SD 1.09). Independent predictors of medical defect size progression were bipolar defects (beta 0.47 SE 0.08; p < 0.001), knee varus (per degree, beta 0.08 SE 0.03; p = 0.02) and increased weight (per kg, beta = 0.01 SE 0.004; p = 0.01). Independent predictors for lateral defect progression were larger baseline defect size (per 1.0 cm2, beta 0.14 SE 0.03; p < 0.001) and tibial sided defects (beta 0.12 SE 0.04) and degrees valgus (per degree, beta 0.04 SE 0.01; p = 0.001).

Conclusions

Medial compartment full-thickness defects progress at a more rapid rate than lateral defects in older adults with minimal to moderate OA. Medial defect progression was greatest for bipolar defects in heavier adults with varus knees. Lateral defect progression was greatest for large tibial-sided defects in adults with valgus knees.

Level of evidence

II.

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Acknowledgements

The OAI is a public–private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation; GlaxoSmithKline and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.

Funding

David C. Flanigan reports consulting fees from Zimmer, DePuy Mitek, and Smith and Nephew.

Author information

Authors and Affiliations

  1. Division of Sports Medicine, Department of Orthopaedics, Cartilage Repair Center, The Ohio State University, Columbus, OH, USA

    Joshua S. Everhart, Moneer M. Abouljoud, Sarah G. Poland & David C. Flanigan

  2. Jameson Crane Sports Medicine Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA

    David C. Flanigan

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  1. Joshua S. Everhart
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  2. Moneer M. Abouljoud
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  4. David C. Flanigan
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Correspondence to David C. Flanigan.

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Conflict of interest

David C. Flanigan reports consulting fees from Zimmer, DePuy Mitek, and Smith and Nephew. For the remaining authors none were declared.

Ethical approval

The study protocol, amendments, and informed consent documentation were reviewed and approved by the Institutional Review Boards at all participating sites.

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Everhart, J.S., Abouljoud, M.M., Poland, S.G. et al. Medial compartment defects progress at a more rapid rate than lateral cartilage defects in older adults with minimal to moderate knee osteoarthritis (OA): data from the OA initiative. Knee Surg Sports Traumatol Arthrosc 27, 2401–2409 (2019). https://doi.org/10.1007/s00167-018-5202-1

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