Radiographic evaluation of knee osteoarthritis in predicting outcomes after arthroscopic partial meniscectomy

Background: Knee osteoarthritis (OA) severity is a predictor of outcomes after arthroscopic partial meniscectomy (APM). Magnetic resonance imaging (MRI) grading of OA is predictive of postoperative outcomes; this prospective study assessed whether radiographic grading is also predictive of outcomes. Methods: Patients who underwent APM between February 2015 and January 2016, underwent radiography and MRI <= 6 months before surgery, and had outcomes from the surgery date and one year later were induded. Surgical failure was defined as <10-point improvement in the Knee Osteoarthritis Outcome Score pain subscore. Radiographs were evaluated using Kellgren-Lawrence (KL) grading and continuous and ordinal minimum joint space width (mJSW) measurements; cartilage loss on MRI was evaluated using a modified Outerbridge system. Predictive abilities were estimated using area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs). Results: The study cohort included 66 knees from 64 patients (32 women; mean age, 57.1 years; range, 45-77). Radiographic grading was not predictive of outcomes (KL, AUC 0.541 [95% CI: 0358, 0.724]; continuous mJSW, AUC = 0.482 [95% CI: 0305, 0.659]; ordinal mJSW, AUC = 0.534 [95% CI: 0.433, 0.6341). Comparison of radiographs showing no joint space narrowing (KL grade 0-2) with corresponding MR images demonstrated that 48% of radiographs missed a clinically significant lesion (modified Outerbridge grade >= 3). MRI grading was predictive of outcomes (AUC = 0.720 [95% CI: 0.581, 0.859]). Conclusions: Radiographic grading of OA is not predictive of outcomes after APM; radiographs may miss clinically significant lesions. For outcome prediction, MRI should be used. (C) 2020 Elsevier B.V. All rights reserved.