The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis

Abstract

Objective. To determine the relationship between radiographic progression of joint space narrowing and cartilage loss on magnetic resonance imaging (MRI) in patients with symptomatic knee osteoarthritis (OA), and to investigate the location of MRI-based cartilage loss in the knee and its relation to radiographic progression.Methods. Two hundred twenty-four men and women (mean age 66 years) were studied. Radiographs and MRI of the more symptomatic knee were obtained at baseline and at 15-and 30-month followup. Radiographs of the knee (with weight-bearing) were read for joint space narrowing (scale 0-3), with progression defined as any worsening in score. We used a semiquantitative method to score cartilage morphology in all 5 regions of the tibiofemoral joint, and defined cartilage loss as an increase in score (scale 0-4) at any region. We examined the relationship between progression of joint space narrowing on radiographic images and cartilage loss on MRI, using a generalized estimating equation proportional odds logistic regression, adjusted for baseline cartilage score, age, body mass index, and sex. The medial and lateral compartments were analyzed separately.Results. In the medial compartment, 104 knees (46%) had cartilage loss detected by MRI. The adjusted odds ratio was 3.7 (95% confidence interval 2.2-6.3) for radiographic progression being predictive of cartilage loss on MRI. However, there was still a substantial proportion of knees (80 of 189 [42%]) with cartilage loss visible on MRI when no radiographic progression was apparent. Cartilage loss occurred frequently in the central regions of the femur and tibia as well as the posterior femur region, but radiographic progression was less likely to be observed when posterior femur regions showed cartilage loss. Radiographic progression appeared specific (91%) but not sensitive (23%) for cartilage loss. Overall findings were similar for the lateral compartment.Conclusion. While our results provide longitudinal evidence that radiographic progression of joint space narrowing is predictive of cartilage loss assessed on MRI, radiography is not a sensitive measure, and if used alone, will miss a substantial proportion of knees with cartilage loss.

Effect of recreational physical activities on the development of knee osteoarthritis in older adults of different weights: The Framingham Study

“…Although the fully extended AP weightbearing radiograph is probably no longer acceptable as a single modality for evaluating joint space loss, our use of lateral radiographs to evaluate the tibiofemoral joint space has recently been validated compared with fluoroscopy and also correlates with MRI-based cartilage loss (19). The majority of joint space loss in our cohort was seen on both the lateral and AP views.…”

“…We and others have shown that joint space loss is related to cartilage loss (19). We defined the knee as having had joint space loss when there was a 1-grade change (e.g., 0 -1 or 1-2) on either the lateral view or the AP view in the tibiofemoral joint from baseline to followup.…”

Quantitative MRI of cartilage and bone: degenerative changes in osteoarthritis

“…In another sample of 224 women and men with symptomatic knee OA, Amin et al (224) reported a longitudinal increase in semiquantitative MRI cartilage grading scores to be significantly associated with (semiquantitatively graded) JSN of weight-bearing femorotibial radiographs. However, progression of cartilage lesions was observed in a substantial portion of knees (42%) in which no radiographic change was apparent.…”

Effects of long-term estrogen replacement therapy on bone turnover in periarticular tibial osteophytes in surgically postmenopausal cynomolgus monkeys

“…The most likely explanation for all of these findings is that the medial joint compartment is more severely affected by OA than the lateral compartment in this model. This probably relates to biomechanical factors, since the medial joint compartment receives a greater load than the lateral compartment in most species [13,14]. In cynomolgus monkeys, the medial joint compartment precedes the lateral compartment in the development of OA lesions, possibly due at least in part to these differences in joint loading [15].…”