<jats:title>Abstract</jats:title><jats:sec> <jats:title>Objective</jats:title> <jats:p>To explore whether and which quantitative 3D measures of medial and/or lateral meniscus position and size are associated with subsequent medial femorotibial structural progression of knee osteoarthritis and to determine the correlation between central slice and total meniscus measures.</jats:p> </jats:sec><jats:sec> <jats:title>Materials and Methods</jats:title> <jats:p>Knees with radiographic osteoarthritis from Osteoarthritis Initiative participants with longitudinal medial MRI-based cartilage thickness and radiographic joint space width (JSW) loss over 12 months were selected. These 37 structural progressor knees (64.7 ± 8.0y, 30.2 ± 4.6 kg/m<jats:sup>2</jats:sup>, 35% men) were matched 1:1 to 37 non-progressor knees (64.6 ± 9.8y, 30.2 ± 4.4 kg/m<jats:sup>2</jats:sup>, 35% men) without cartilage thickness or JSW loss. Quantitative measures of meniscus position and size were computed from manual segmentations of coronal baseline MRIs. Cohen’s D was used as measure of effect size.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Maximum extrusion distance of the total medial meniscus and mean extrusion in the central 5 and in the central slice were greater for progressor than non-progressor knees (Cohen’s D 0.58–0.66). No significant differences were observed for medial tibial coverage or mean extrusion (entire meniscus). Among medial meniscus morphology measures, only mean height differed between progressor vs non-progressor knees (Cohen’s D 0.40). Among lateral meniscus measures, height and volume were greater in progressor vs. non-progressor knees (Cohen’s D 0.46–0.83). Mean extrusion measures were highly correlated between the entire meniscus and the central (<jats:italic>r</jats:italic> = 0.88) or the central 5 (<jats:italic>r</jats:italic> = 0.93) slices.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>3D maximum and central medial meniscus extrusion may serve as predictors for subsequent structural progression. Central meniscus extrusion measures could substitute 3D extrusion measurement across the entire meniscus.</jats:p> </jats:sec>