Ultrasonography findings in knee osteoarthritis: a prospective observational cross-sectional study of 100 patients

Abstract

Worldwide, knee osteoarthritis (KOA) accounts for 2.2% of total years lived with disability. There is a low correlation between joint tissue damage and pain intensity. Periarticular structures may be involved and cannot be identified in X-rays. To describe the main ultrasonography (USG) changes in symptomatic patients with primary KOA; to correlate the number of USG findings with KOA severity assessed by Kellgren and Lawrence (K&L) radiological scores, with pain intensity measured by a visual analogue scale (VAS) and with functioning scores assessed with the Timed up and go test (TUG) and Western Ontario and McMaster Universities (WOMAC) questionnaire. 100 patients with primary symptomatic KOA were assessed with X-ray and USG. Quantitative and qualitative analyses were evaluated in a systematic manner. The most frequent findings were joint effusion, pes anserinus bursitis, quadriceps tendon enthesopathy, popliteal cyst, iliotibial band tendinitis and patellar tendinitis. Pearson’s correlation analysis demonstrated a significant moderate positive association between VAS scores and the number of USG findings (r = 0.36; p < 0.0001). The number of USG findings was different between K&L grades I and III (p = 0.041), I and IV (p < 0.001), and II and IV (p = 0.001, analysis of variance with Bonferroni correction). There was significant association between number of USG findings and TUG (r = 0.18; p = 0.014) and WOMAC scores for pain (r = 0.16; p < 0.029) and physical function domains (r = 0.16; p < 0.028). The most frequent USG finding was joint effusion. Periarticular structures should be explored as potential sources of pain and disability.

The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis

“…On the other hand, ultrasonography is classically recommended to assess joint effusion osteophytes, narrowing of joint space and other features ( 45 ). Besides joint effusion, we have also demonstrated a significant percentage of knee OA patients with pes anserine bursitis, patellar tendinitis and popliteal cysts ( 28 ). Our study identified USG changes in 78% of the examined knees.…”

“…Main USG findings were small to moderate joint effusion, pes anserinus bursitis, quadriceps enthesopathy, popliteal cyst, iliotibial band tendonitis and patellar tendinitis. Together with the high prevalence of USG findings, we identified a significant positive correlation between the number of USG findings and pain intensity scores measured by a VAS (28). These periarticular changes are also sources of knee pain and target for interventions including radial shockwave therapies (46)(47)(48)(49)(50).…”

“…We used focal extracorporeal shockwaves to manage pain deriving from the knee joint. The present protocol also used ultrasonography to identify peripheral soft tissue changes including patella tendinitis, pes anserinus bursitis among others ( 28 ). For these periarticular soft tissue abnormal findings, we used radial pressure wave therapy.…”

On-site Ultrasound Screens out Asymptomatic Knee Lesions in Elite Adolescent Male Basketball Players

“…For specific ultrasonographic findings, the incidence of suprapatellar recess effusion was 55.26% and significantly higher than in control group (0.00%). Although ultrasonographic findings, including suprapatellar effusion, popliteal cyst, pes anserinus bursitis, suprapatellar tendinitis, were shown to be significantly correlated with pain intensity in knee osteoarthritis patients [25], no relationship between symptom and knee effusion alone was reported. Additional analysis of our data was done among player groups, which showed no difference of IKDC-SKF score between ultrasonographic effusion positive and negative knees of players (77.82 vs 76.56, P=0.77, unpaired t-test).…”

Role of global femoral cartilage in assessing severity of primary knee osteoarthritis

“…Since then more research has been conducted on tools more accurately depicting early cartilage and soft tissue damage as MRI and US. Since MRI is an expensive tool, and not readily available in any clinical setting, more effort was invested with US and its capability in defining those early soft tissue changes in KOA especially the ones related to pain and eventually leading to loss of function as concluded by Abicalaf et al [31]. Recently ultrasound has become popular among rheumatologists as the first-choice imaging for the evaluation and monitoring of KOA.…”