Objective: To explore the relationship between meniscal degeneration (intrameniscal signal alteration without a tear) and future osteoarthritis pathology measured by composite scores based on magnetic resonance imaging (MRI): disease activity (bone marrow lesion and effusion-synovitis volumes) and cumulative damage (articular cartilage damage).

Design: This analysis involved 225 participants from the Osteoarthritis Initiative with intact menisci (defined as normal or meniscal degeneration without tear) on MRI and no radiographic knee osteoarthritis at baseline. We used longitudinal MRIs from an existing study to calculate disease activity and cumulative damage. We used robust regression models to assess the association between baseline meniscal degeneration (exposure) and disease activity or cumulative damage at baseline and four annual follow-up visits (outcomes), adjusting for gender, race, age, static alignment, and body mass index.

Results: Our sample included 110 participants with normal menisci (77% Female, 55 [SD 7] average years of age) and 115 with meniscal degeneration (60% Female, 61 [SD 9] average years of age). Knees with meniscal degeneration were more likely to have, on average, 0.21 greater disease activity at 12 months than knees with normal menisci (parameter estimate=0.21, 95% CI=0.09, 0.33); this association persisted over time. In contrast, the association between meniscal degeneration and cumulative damage only became statistically significant at the 48-month visit (parameter estimate=0.74, 95% CI=0.18, 1.31).

Conclusions: Meniscal degeneration related to worsening disease activity earlier than articular cartilage damage among knees without radiographic osteoarthritis. Meniscal degeneration and disease activity are promising biomarkers for early detection, monitoring osteoarthritis, and informing potential early intervention strategies.