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Research project

Meniscus pathologies in knee osteoarthritis development

Status: Ongoing (2015 - 2022)

By using the data from the PROOF and Rotterdam study, we aim to analyze different meniscus characteristics and pathologies, like meniscus volume, extrusion, and tears and their role in knee osteoarthritis development. We will also perform osteoarthritis animal models to study meniscus pathology mechanisms.

What we do

About our project

A ‘meniscal pathway’ to knee OA was implicated by a loss of meniscal function due to damage or extrusion, leading to cartilage loss, subchondral bone changes, bone marrow lesions and synovitis, eventually resulting in pain and definite OA. Therefore, it is important to assess the presence of meniscal pathologies when studying early stage knee OA.

We hypothesize that meniscus pathologies (e.g. extrusion, swelling, tear) play an essential role in knee OA development.

Data from the Prevention of knee Osteoarthritis in Overweight Females study and Rotterdam Study will be used.

The PROOF cohort included 407 women with a BMI ≥27 kg/m2, free of OA related symptoms.
The Rotterdam Study (RS) is a population-based prospective cohort study ongoing since 1990, which include 3 subpopulation.

The outcome measure will be the incidence of clinical and radiographic knee OA. All menisci at all time-points were automatically segmented to obtain the meniscal volume and delta-volumes. Generalized estimating equations were used to evaluate associations between the volume measures and the outcomes. Structural equation model was built to investigate the interplay between different meniscus pathologies and radiographic OA outcome.

Results will be validated using data from the Rotterdam Study, the OAI, and CHECK.

Our research focus

Primary outcome
The primary outcome measure was the incidence of knee OA which include radiographic and clinical defined OA.

Funds & Grants

The China Scholarship Council


Internal collaborations
Department of Orthopedic Surgery and the Orthopedic Lab
Department of Radiology & Nuclear Medicine

External collaborations
Maasstad Hospital, Dept. Radiology
Lund University, Dept. Orthopedics


Xu D, van der Voet J, Hansson NM, Klein S, Oei EHG, Wagner F, Bierma-Zeinstra SMA, Runhaar J. Association between meniscal volume and development of knee osteoarthritis. Rheumatology (Oxford). 2020 Sep 25:keaa522. doi: 10.1093/rheumatology/keaa522.

van der Voet JA, Runhaar J, van der Plas P, Vroegindeweij D, Oei EH, Bierma-Zeinstra SMA. Baseline meniscal extrusion associated with incident knee osteoarthritis after 30 months in overweight and obese women. Osteoarthritis Cartilage. 2017 Aug;25(8):1299-1303. doi: 10.1016/j.joca.2017.03.014.

Zhang F, Bierma-Zeinstra SM, Oei EHG, Turkiewicz A, Englund M, Runhaar J. Factors associated with meniscal body extrusion on knee MRI in overweight and obese women. Osteoarthritis Cartilage. 2017 May;25(5):694-699. doi: 10.1016/j.joca.2016.12.001.

Our team

Dr. J. Runhaar (co-promotor), j.runhaar@erasmusmc.nl
D. Xu, MD, d.xu@erasmusmc.nl
J. van der Voet, MD, j.vandervoet@erasmsumc.nl
Dr. E. Oei, e.oei@erasmusmc.nl
Dr. D. Vroegindeweij, vroegindeweijd@maassatdziekenhuis.nl
Prof. S.M.A. Bierma-Zeinstra (promotor), s.bierma-zeinstra@erasmusmc.nl

Contact addresses for the project: d.xu@erasmusmc.nl and j.vandervoet@erasmusmc.nl.