2025 ISAKOS Biennial Congress ePoster
Role of Medial Menisco-Tibial Ligament Enthesis in knee Osteoarthritis Initiation
Hiroaki Tsukamoto, MD,PhD, Noshiro, Akita JAPAN
Manabu Akagawa, MD, PhD, Akita City, Akita JAPAN
Hidetomo Saito, MD, PhD, Akita JAPAN
Naohisa Miyakoshi, MD, PhD, Akita JAPAN
Noshiro Kosei Medical Center, Noshiro, Akita, JAPAN
FDA Status Cleared
Summary
MTL insufficiency due to inflammation of the MTL enthesis was considered as the cause of meniscal extrusion.
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Abstract
Introduction
Recent studies have shown that inflammation of the ligamentous attachments (Synovio-Enthesis Complex: SEC) is important in the pathogenesis of osteoarthritis (OA). In the early stages of knee OA, meniscal extrusion is closely involved as a mechanical factor, and the menisco-tibial ligament (MTL) insufficiency has been reported as one of the causes of the extrusion. However, the relationship between SEC pathologies, meniscus extrusion, and MTL insufficiency has not been known. Therefore, we aimed to investigate the relationship between SEC pathologies, medial MTL status, and medial meniscus extrusion (MME). Methods: 82 patients with medial compartmental knee OA (62.5 ± 10.3 years old, 18 men and 64 women) were included in the study. The OMERACT Enthesitis Score on knee MRI was used to quantitatively evaluate SEC pathologies on the medial MTL. The prevalence of eight MRI findings 1) Intra-ligament hypersignal, 2) Peri-ligament hypersignal, 3) Bone marrow edema, 4) Bursitis, 5) Entheseal thickening, 6) Osteophyte, 7) Bone erosion, 8) Intra-ligament hypersignal on T1wight view were investigated. The relationship between OMERACT score, MME, and MTL insufficiency was investigated using covariance structural analysis. Results: There was a prevalence of peri-ligament hypersignal (95%) and osteophyte (81%), bone marrow edema (56%), intra-ligament hypersignal (52%), Entheseal thickening (38%), intra-ligament Hypersignal on T1 weighted view, bursitis (12%), and bone erosion (6%). The mean MME was 2.24 (0.57 - 8.89) mm. The prevalence of MTL insufficiency was 66%. Total inflammatory score for MTL enthesis was 3.26 (1.02 - 5.32) and total structural score 1.77 (0.75 - 4.23). Covariance structural analysis revealed a higher frequency of MTL insufficiency in patients with inflammation in the SEC, resulting in a more pronounced meniscal extrusion. Conclusion: MTL insufficiency due to inflammation of the MTL enthesis was considered as the cause of meniscal extrusion.