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Osteoarthritis of Knee
Eva M. Escobedo, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Osteoarthritis (OA)
        • Synonyms

          • Degenerative joint disease (DJD), osteoarthrosis
        • Definitions

          • Arthritis developing secondary to cartilage degeneration
            • Results from imbalance between biosynthesis and degradation of cartilage constituents; degradative processes outpace repair
            • Presently defined as productive radiographic changes in combination with joint pain
            • Cartilage loss occurs for several years before OA visible on radiograph; definition may be refined in future
              • 55% of patients with tibiofemoral compartment cartilage degeneration at arthroscopy had no radiographic evidence of OA in 1 study

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Guan B et al: Deep learning approach to predict pain progression in knee osteoarthritis. Skeletal Radiol. 51(2):363-73, 2021
                                      2. Lee LS et al: Imaging of knee osteoarthritis: a review of current evidence and clinical guidelines. Musculoskeletal Care. 19(3):363-74, 2021
                                      3. Xie Y et al: Metabolic syndrome, hypertension, and hyperglycemia were positively associated with knee osteoarthritis, while dyslipidemia showed no association with knee osteoarthritis. Clin Rheumatol. 40(2):711-24, 2021
                                      4. Leung K et al: Prediction of total knee replacement and diagnosis of osteoarthritis by using deep learning on knee radiographs: data from the osteoarthritis initiative. Radiology. 296(3):584-93, 2020
                                      5. Liu Y et al: Threshold for lateral meniscal body extrusion on MRI in middle-aged and elderly patients with symptomatic knee osteoarthritis. Diagn Interv Imaging. 101(10):677-83, 2020
                                      6. Roemer FW et al: MRI-based screening for structural definition of eligibility in clinical DMOAD trials: rapid OsteoArthritis MRI Eligibility Score (ROAMES). Osteoarthritis Cartilage. 28(1):71-81, 2020
                                      7. Roemer FW et al: State of the art: imaging of osteoarthritis-revisited 2020. Radiology. 296(1):5-21, 2020
                                      8. Thomas KA et al: Automated classification of radiographic knee osteoarthritis severity using deep neural networks. Radiol Artif Intell. 2(2):e190065, 2020
                                      9. Norman B et al: Applying densely connected convolutional neural networks for staging osteoarthritis severity from plain radiographs. J Digit Imaging. 32(3):471-7, 2019
                                      10. Yang X et al: Efficacy of magnetic resonance imaging with an SPGR sequence for the early evaluation of knee cartilage degeneration and the relationship between cartilage and other tissues. J Orthop Surg Res. 14(1):152, 2019
                                      11. Expert Panel on Musculoskeletal Imaging:. et al: ACR Appropriateness Criteria® Chronic Knee Pain. J Am Coll Radiol. 15(11S):S302-12, 2018
                                      12. Rueckl K et al: The posterior-anterior flexed view is better than the anterior-posterior view for assessing osteoarthritis of the knee. Skeletal Radiol. 47(4):511-7, 2018
                                      13. Wang X et al: What is the role of imaging in the clinical diagnosis of osteoarthritis and disease management? Rheumatology (Oxford). 57(suppl_4):iv51-60, 2018
                                      14. van Oudenaarde K et al: Predictive value of MRI features for development of radiographic osteoarthritis in a cohort of participants with pre-radiographic knee osteoarthritis-the CHECK study. Rheumatology (Oxford). 56(1):113-20, 2017
                                      15. Bastick AN et al: What are the prognostic factors for radiographic progression of knee osteoarthritis? A meta-analysis. Clin Orthop Relat Res. 473(9):2969-89, 2015
                                      16. Alizai H et al: Cartilage lesion score: comparison of a quantitative assessment score with established semiquantitative MR scoring systems. Radiology. 271(2):479-87, 2014
                                      17. Guermazi A et al: Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study. Radiology. 268(3):814-21, 2013
                                      18. Kijowski R et al: Evaluation of the articular cartilage of the knee joint: value of adding a T2 mapping sequence to a routine MR imaging protocol. Radiology. 267(2):503-13, 2013
                                      19. Park HJ et al: A practical MRI grading system for osteoarthritis of the knee: association with Kellgren-Lawrence radiographic scores. Eur J Radiol. 82(1):112-7, 2013
                                      20. Raya JG et al: Diffusion-tensor imaging of human articular cartilage specimens with early signs of cartilage damage. Radiology. 266(3):831-41, 2013
                                      21. Crema MD et al: Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: the Multicenter Osteoarthritis study. Radiology. 264(2):494-503, 2012
                                      22. Hunter DJ et al: Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis Cartilage. 19(8):990-1002, 2011
                                      23. Mosher TJ et al: Knee articular cartilage damage in osteoarthritis: analysis of MR image biomarker reproducibility in ACRIN-PA 4001 multicenter trial. Radiology. 258(3):832-42, 2011
                                      24. Pan J et al: Knee cartilage T2 characteristics and evolution in relation to morphologic abnormalities detected at 3-T MR imaging: a longitudinal study of the normal control cohort from the Osteoarthritis Initiative. Radiology. 261(2):507-15, 2011
                                      25. Lo GH et al: Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage. 17(12):1562-9, 2009
                                      26. Stahl R et al: Assessment of cartilage-dedicated sequences at ultra-high-field MRI: comparison of imaging performance and diagnostic confidence between 3.0 and 7.0 T with respect to osteoarthritis-induced changes at the knee joint. Skeletal Radiol. 38(8):771-83, 2009
                                      27. Takahashi T et al: Reproducibility of joint space width and the intermargin distance measurements in patients with medial osteoarthritis of the knee in various degrees of flexion. Skeletal Radiol. 38(1):37-42, 2009
                                      28. Anandacoomarasamy A et al: Predictors of clinical response to intraarticular Hylan injections -- a prospective study using synovial fluid measures, clinical outcomes, and magnetic resonance imaging. J Rheumatol. 35(4):685-90, 2008
                                      29. Chan WP et al: Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain. Skeletal Radiol. 37(10):917-22, 2008
                                      30. Englund M et al: Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 359(11):1108-15, 2008
                                      31. Hernández JL et al: Aromatase expression in osteoarthritic and osteoporotic bone. Arthritis Rheum. 58(6):1696-700, 2008
                                      32. Kessler MA et al: Recovery of the menisci and articular cartilage of runners after cessation of exercise: additional aspects of in vivo investigation based on 3-dimensional magnetic resonance imaging. Am J Sports Med. 36(5):966-70, 2008
                                      33. Krampla WW et al: Changes on magnetic resonance tomography in the knee joints of marathon runners: a 10-year longitudinal study. Skeletal Radiol. 37(7):619-26, 2008
                                      34. Owman H et al: Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis. Arthritis Rheum. 58(6):1727-30, 2008
                                      35. Pouders C et al: Prevalence and MRI-anatomic correlation of bone cysts in osteoarthritic knees. AJR Am J Roentgenol. 190(1):17-21, 2008
                                      36. Rauscher I et al: Meniscal measurements of T1rho and T2 at MR imaging in healthy subjects and patients with osteoarthritis. Radiology. 249(2):591-600, 2008
                                      37. Thomas E et al: Predicting the course of functional limitation among older adults with knee pain: do local signs, symptoms and radiographs add anything to general indicators? Ann Rheum Dis. 67(10):1390-8, 2008
                                      38. Felson DT et al: Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging. Arthritis Rheum. 56(9):2986-92, 2007
                                      39. Kijowski R et al: Arthroscopic validation of radiographic grading scales of osteoarthritis of the tibiofemoral joint. AJR Am J Roentgenol. 187(3):794-9, 2006
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Osteoarthritis (OA)
                                            • Synonyms

                                              • Degenerative joint disease (DJD), osteoarthrosis
                                            • Definitions

                                              • Arthritis developing secondary to cartilage degeneration
                                                • Results from imbalance between biosynthesis and degradation of cartilage constituents; degradative processes outpace repair
                                                • Presently defined as productive radiographic changes in combination with joint pain
                                                • Cartilage loss occurs for several years before OA visible on radiograph; definition may be refined in future
                                                  • 55% of patients with tibiofemoral compartment cartilage degeneration at arthroscopy had no radiographic evidence of OA in 1 study

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Gross Pathologic & Surgical Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Guan B et al: Deep learning approach to predict pain progression in knee osteoarthritis. Skeletal Radiol. 51(2):363-73, 2021
                                                                          2. Lee LS et al: Imaging of knee osteoarthritis: a review of current evidence and clinical guidelines. Musculoskeletal Care. 19(3):363-74, 2021
                                                                          3. Xie Y et al: Metabolic syndrome, hypertension, and hyperglycemia were positively associated with knee osteoarthritis, while dyslipidemia showed no association with knee osteoarthritis. Clin Rheumatol. 40(2):711-24, 2021
                                                                          4. Leung K et al: Prediction of total knee replacement and diagnosis of osteoarthritis by using deep learning on knee radiographs: data from the osteoarthritis initiative. Radiology. 296(3):584-93, 2020
                                                                          5. Liu Y et al: Threshold for lateral meniscal body extrusion on MRI in middle-aged and elderly patients with symptomatic knee osteoarthritis. Diagn Interv Imaging. 101(10):677-83, 2020
                                                                          6. Roemer FW et al: MRI-based screening for structural definition of eligibility in clinical DMOAD trials: rapid OsteoArthritis MRI Eligibility Score (ROAMES). Osteoarthritis Cartilage. 28(1):71-81, 2020
                                                                          7. Roemer FW et al: State of the art: imaging of osteoarthritis-revisited 2020. Radiology. 296(1):5-21, 2020
                                                                          8. Thomas KA et al: Automated classification of radiographic knee osteoarthritis severity using deep neural networks. Radiol Artif Intell. 2(2):e190065, 2020
                                                                          9. Norman B et al: Applying densely connected convolutional neural networks for staging osteoarthritis severity from plain radiographs. J Digit Imaging. 32(3):471-7, 2019
                                                                          10. Yang X et al: Efficacy of magnetic resonance imaging with an SPGR sequence for the early evaluation of knee cartilage degeneration and the relationship between cartilage and other tissues. J Orthop Surg Res. 14(1):152, 2019
                                                                          11. Expert Panel on Musculoskeletal Imaging:. et al: ACR Appropriateness Criteria® Chronic Knee Pain. J Am Coll Radiol. 15(11S):S302-12, 2018
                                                                          12. Rueckl K et al: The posterior-anterior flexed view is better than the anterior-posterior view for assessing osteoarthritis of the knee. Skeletal Radiol. 47(4):511-7, 2018
                                                                          13. Wang X et al: What is the role of imaging in the clinical diagnosis of osteoarthritis and disease management? Rheumatology (Oxford). 57(suppl_4):iv51-60, 2018
                                                                          14. van Oudenaarde K et al: Predictive value of MRI features for development of radiographic osteoarthritis in a cohort of participants with pre-radiographic knee osteoarthritis-the CHECK study. Rheumatology (Oxford). 56(1):113-20, 2017
                                                                          15. Bastick AN et al: What are the prognostic factors for radiographic progression of knee osteoarthritis? A meta-analysis. Clin Orthop Relat Res. 473(9):2969-89, 2015
                                                                          16. Alizai H et al: Cartilage lesion score: comparison of a quantitative assessment score with established semiquantitative MR scoring systems. Radiology. 271(2):479-87, 2014
                                                                          17. Guermazi A et al: Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study. Radiology. 268(3):814-21, 2013
                                                                          18. Kijowski R et al: Evaluation of the articular cartilage of the knee joint: value of adding a T2 mapping sequence to a routine MR imaging protocol. Radiology. 267(2):503-13, 2013
                                                                          19. Park HJ et al: A practical MRI grading system for osteoarthritis of the knee: association with Kellgren-Lawrence radiographic scores. Eur J Radiol. 82(1):112-7, 2013
                                                                          20. Raya JG et al: Diffusion-tensor imaging of human articular cartilage specimens with early signs of cartilage damage. Radiology. 266(3):831-41, 2013
                                                                          21. Crema MD et al: Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: the Multicenter Osteoarthritis study. Radiology. 264(2):494-503, 2012
                                                                          22. Hunter DJ et al: Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis Cartilage. 19(8):990-1002, 2011
                                                                          23. Mosher TJ et al: Knee articular cartilage damage in osteoarthritis: analysis of MR image biomarker reproducibility in ACRIN-PA 4001 multicenter trial. Radiology. 258(3):832-42, 2011
                                                                          24. Pan J et al: Knee cartilage T2 characteristics and evolution in relation to morphologic abnormalities detected at 3-T MR imaging: a longitudinal study of the normal control cohort from the Osteoarthritis Initiative. Radiology. 261(2):507-15, 2011
                                                                          25. Lo GH et al: Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage. 17(12):1562-9, 2009
                                                                          26. Stahl R et al: Assessment of cartilage-dedicated sequences at ultra-high-field MRI: comparison of imaging performance and diagnostic confidence between 3.0 and 7.0 T with respect to osteoarthritis-induced changes at the knee joint. Skeletal Radiol. 38(8):771-83, 2009
                                                                          27. Takahashi T et al: Reproducibility of joint space width and the intermargin distance measurements in patients with medial osteoarthritis of the knee in various degrees of flexion. Skeletal Radiol. 38(1):37-42, 2009
                                                                          28. Anandacoomarasamy A et al: Predictors of clinical response to intraarticular Hylan injections -- a prospective study using synovial fluid measures, clinical outcomes, and magnetic resonance imaging. J Rheumatol. 35(4):685-90, 2008
                                                                          29. Chan WP et al: Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain. Skeletal Radiol. 37(10):917-22, 2008
                                                                          30. Englund M et al: Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 359(11):1108-15, 2008
                                                                          31. Hernández JL et al: Aromatase expression in osteoarthritic and osteoporotic bone. Arthritis Rheum. 58(6):1696-700, 2008
                                                                          32. Kessler MA et al: Recovery of the menisci and articular cartilage of runners after cessation of exercise: additional aspects of in vivo investigation based on 3-dimensional magnetic resonance imaging. Am J Sports Med. 36(5):966-70, 2008
                                                                          33. Krampla WW et al: Changes on magnetic resonance tomography in the knee joints of marathon runners: a 10-year longitudinal study. Skeletal Radiol. 37(7):619-26, 2008
                                                                          34. Owman H et al: Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis. Arthritis Rheum. 58(6):1727-30, 2008
                                                                          35. Pouders C et al: Prevalence and MRI-anatomic correlation of bone cysts in osteoarthritic knees. AJR Am J Roentgenol. 190(1):17-21, 2008
                                                                          36. Rauscher I et al: Meniscal measurements of T1rho and T2 at MR imaging in healthy subjects and patients with osteoarthritis. Radiology. 249(2):591-600, 2008
                                                                          37. Thomas E et al: Predicting the course of functional limitation among older adults with knee pain: do local signs, symptoms and radiographs add anything to general indicators? Ann Rheum Dis. 67(10):1390-8, 2008
                                                                          38. Felson DT et al: Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging. Arthritis Rheum. 56(9):2986-92, 2007
                                                                          39. Kijowski R et al: Arthroscopic validation of radiographic grading scales of osteoarthritis of the tibiofemoral joint. AJR Am J Roentgenol. 187(3):794-9, 2006