Aug 2026· Journal of Evidence-Based Medicine· pp.
e70182
· 0 citations· 40 references
Medicine
TL;DR
Ass associations of symptomatic, radiographic, and structural knee indicators with radiographic osteoarthritis (OA) progression in the contralateral knee among individuals with or at risk of OA are investigated, suggesting contralateral knee condition should be considered in OA evaluation.
Abstract
Aim
To investigate associations of symptomatic, radiographic, and structural knee indicators with radiographic osteoarthritis (OA) progression in the contralateral knee among individuals with or at risk of OA.
Methods
Data were obtained from the Osteoarthritis Initiative Database (accessed on December 21, 2022), with knees as the unit of analysis. Baseline exposures included symptomatic measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Knee injury and Osteoarthritis Outcome Score), radiographic features (radiographic OA status, Kellgren-Lawrence [KL] grades, joint space width [JSW], and alignment), and magnetic resonance imaging (MRI)-based structural abnormalities (MRI Osteoarthritis Knee Score [MOAKS]-assessed lesions including cartilage defects, bone marrow lesions, meniscal morphology, Hoffa-synovitis, and effusion-synovitis). Outcomes were 4-year contralateral KL grades and 4-year JSW change. Generalized estimating equation models were used.
Results
Each 1-point increase in WOMAC total score was associated with increased contralateral KL grades (β = 0.002, 95% confidence interval [CI], 0.001 to 0.003) and greater medial JSW narrowing (β = -0.005 mm, 95% CI, -0.007 to -0.003 mm). Radiographic OA status was associated with higher KL grades (β = 0.112, 95% CI, 0.088 to 0.136) and reduced medial JSW (β = -0.179 mm, 95% CI, -0.236 to -0.122 mm) and lateral JSW (β = -0.168 mm, 95% CI, -0.257 to -0.079 mm). MRI-based analyses showed that MOAKS-defined structural damage was associated with greater contralateral JSW loss, with compartment-specific patterns. Each 1-point increase in medial tibiofemoral (TF) joint bone marrow lesion (BML) size was associated with a 0.045 mm decrease in contralateral medial JSW (95% CI, -0.065 to -0.025 mm), while each 1-point increase lateral TF joint BML size was associated with a 0.048 mm decrease in contralateral lateral JSW (95% CI, -0.084 to -0.012 mm).
Conclusions
Worse symptomatic, radiographic, and structural knee status is associated with contralateral radiographic OA progression, suggesting contralateral knee condition should be considered in OA evaluation.
There is a need for an integrated assessment combining clinical evaluation and radiological findings to guide treatment planning for patients with knee OA, and BMI is a major risk factor for osteoarthritis.
Krishna bahadur Bista, R. Dhakal, Bodh Raj Gautam et al.· A Bi-annual South Asian Jour...· 0 citations
Aims
Musculoskeletal ultrasonography is an accessible imaging modality with potential utility in knee osteoarthritis. This study aims to compare the sonographic features of knee osteoarthritis with standing radiographic grading and to assess the association with pain severity.
Methods
In this cross-sectional study, patients with knee osteoarthritis underwent knee ultrasonography and standing anteroposterior and lateral radiographs. Radiographs were independently assessed by a blinded reviewer and graded using the Kellgren-Lawrence system. Kellgren-Lawrence grades 1-2 were classified as mild osteoarthritis and grades 3-4 as moderate to severe osteoarthritis. Sonographic findings were compared with radiographic grades, and the association with pain severity measured by the visual analogue scale (VAS) was evaluated.
Results
Sonographic measurements of medial femoral osteophytes, suprapatellar effusion, Baker's cyst, and medial meniscal protrusion significantly correlated to radiographic osteoarthritis severity (p ⩽ 0.05). A composite score derived from these four variables demonstrated acceptable diagnostic performance (Youden index: 0.61). This composite score significantly correlated to VAS pain scores (p = 0.003), whereas VAS was not significantly associated with the Kellgren-Lawrence grade.
Conclusion
Ultrasonography may serve as a valuable adjunct or alternative to plain radiography for estimating knee osteoarthritis severity and its clinical impact. Further well-designed studies are warranted to confirm these findings.
Mohadese Yadolahi, Elahe Mohammadnia, E. Hedayat et al.· Ultrasound· 0 citations
OBJECTIVE
To quantify general population prevalence, and differences by sex and BMI, in ultrasound (US) features of knee osteoarthritis (KOA), patient-reported knee symptoms (Ksx), radiographic KOA (rKOA), and symptomatic KOA (sxKOA).
METHODS
Participants from the Johnston County Health Study (2019-2024; n=902) provided demographic, clinical, and imaging data. Ksx was defined as self-reported pain, aching or stiffness on most days of any one month in the past 12 months. rKOA was defined as Kellgren-Lawrence grade ≥2 (or total knee replacement (TKR)), severe rKOA as grades 3-4 (or TKR), and sxKOA as rKOA and Ksx in the same knee. Standardized US scoring was performed as previously reported. Weighted prevalence estimates and 95% confidence intervals (CI) for Ksx, rKOA, sxKOA, severe rKOA, and US features were calculated overall and by sex and BMI category.
RESULTS
Among 902 participants (67% female; 66% non-Hispanic white, mean age 55 years, and BMI 33 kg/m²), the weighted prevalence of Ksx, rKOA, sxKOA, and severe rKOA were 61%, 36%, 27%, and 21%, respectively, all higher (based on non-overlapping CIs) than baseline estimates from the Johnston County Osteoarthritis Project and other cohorts. Ksx, rKOA, sxKOA, and severe rKOA were higher among females and those with obesity. Compared to females with obesity, those with severe obesity had higher prevalence of all radiographic outcomes at moderate and severe grades with non-overlapping CI. US effusion and synovitis were more prevalent in males, whereas medial and lateral cartilage damage were more common in females. With increasing obesity, osteophytes and medial cartilage damage were more prevalent, while gryescale effusion was actually less frequent.
CONCLUSION
KOA prevalence continues to increase in the population. Sex and BMI differences in KOA prevalence and US features were most pronounced among females with severe obesity. Distinguishing between sexes and by obesity levels may improve understanding of KOA mechanisms and guide tailored prevention and treatment strategies.
Maya Patel, C. Alvarez, Todd A. Schwartz et al.· Osteoarthritis and Cartilage· 1 citation
Background Knee osteoarthritis (OA) is a major cause of pain and disability, yet baseline radiographic severity grading provides only modest prediction of structural progression. We evaluated whether structured MRI-derived MOAKS features improve prediction of full-grade medial joint space narrowing (JSN) progression, and whether deep multimodal fusion adds value beyond structured feature models. Methods We performed a patient-independent internal-validation study using the Osteoarthritis Initiative. Full-grade medial joint-space-narrowing (JSN) progression was defined as an increase of at least one grade between baseline and fixed 48-month central radiographic readings from the same longitudinal reading project. The final analytic cohort included 2,899 knees from 2,392 participants, partitioned at the participant level into training, validation, and held-out test sets of 2,050, 421, and 428 knees. We compared a radiographic baseline model (RBM), raw-MOAKS model (RMO), structured MRI/radiographic model (SMR), and radiograph-plus-MOAKS ResNet50 fusion model (XMF). AUPRC was primary; uncertainty was estimated with 2,000 patient-cluster bootstrap replicates. Results Progression prevalence was 10.0%. On the held-out test set (40 progressor knees), AUPRC/AUROC were 0.220 (95% CI 0.142–0.331)/0.748 (0.663–0.827) for RBM, 0.412 (0.260–0.576)/0.805 (0.726–0.878) for RMO, 0.345 (0.219–0.507)/0.801 (0.725–0.871) for SMR, and 0.301 (0.191–0.464)/0.768 (0.679–0.852) for XMF. Compared with RBM, AUPRC increased by 0.192 (0.087–0.313) for RMO and 0.125 (0.042–0.233) for SMR; the corresponding AUROC differences were 0.057 (−0.012 to 0.123) and 0.053 (0.004–0.105). XMF did not improve on SMR in AUPRC or AUROC (differences −0.044 [−0.135 to 0.060] and −0.033 [−0.092 to 0.018], respectively). A stronger clinical-radiographic comparator achieved AUPRC/AUROC 0.251/0.759, increasing to 0.355/0.813 after adding MOAKS. Conclusion Baseline MOAKS features provided prognostic information beyond radiographic or clinical-radiographic severity for fixed 48-month medial JSN progression. In this selected MOAKS-scored cohort, adding a baseline-radiograph ResNet50 encoder did not improve discrimination over the structured models. The finite number of test events, selected MOAKS availability, calibration requirements, and lack of external validation preclude claims of clinical readiness.
Ming-gui Bao, A. Alkhatatbeh, Jiankun Xu et al.· Frontiers in Physiology· 0 citations
USG provides improved detection of osteophytes and offers additional information on soft-tissue and early structural changes in knee OA and serves as a valuable, accessible adjunct to conventional radiography for comprehensive evaluation and early diagnosis of knee OA.
R. Rajkumar, E. D. K. Naidu, Gowthaman Nambiraj et al.· Journal of Clinical and Diag...· 0 citations
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