Imaging of knee osteoarthritis: A review of current evidence and clinical guidelines

Abstract

Background: Knee osteoarthritis (OA) is one of the most common and debilitating degenerative joint diseases worldwide. While radiography is the most commonly used imaging modality, it is associated with drawbacks which newer modalities such as magnetic resonance imaging (MRI) and ultrasound could overcome. Nevertheless, the role of imaging in clinical practice and research in knee OA has not been clearly defined. Furthermore, guidelines on imaging in knee OA from different authoritative bodies have not been compared in previous studies. Therefore, the present review aims to summarise existing evidence and compare guidelines on the use of different imaging modalities in evaluating knee OA.Methods: This is a narrative review based on a search of published clinical guidelines and the PubMed database for articles published between 1 January 1990 and 31 May 2020. Results:There is no broad consensus on the value of imaging in patients with typical OA presentation. If imaging is required, current evidence and clinical guidelines support the use of radiography and MRI as first-and second-line diagnostic modalities respectively. Since radiographic OA features have limited sensitivity and do not manifest in early stages, MRI is the preferred option for whole-joint evaluation in OA research. Discrepancies exist regarding the use of alternative imaging modalities including ultrasound, computed tomography and nuclear medicine. Conclusion:Radiography and MRI are the imaging modalities of choice. Other modalities have their respective advantages, and more research is warranted for the standardisation of image acquisition and interpretation methodology, in order to evaluate their validity, reliability and responsiveness in OA research. K E Y W O R D S clinical guidelines, imaging, knee osteoarthritis 1 | INTRODUCTION Knee osteoarthritis (OA) is one of the most common and debilitating degenerative joint diseases worldwide, with 80% of OA patients suffering from movement limitations and 25% of them being unable to carry out major activities in their daily lives (Neogi, 2013).Although cartilage degeneration and osteophyte formation remain the structural hallmarks of knee OA, the disease is now increasingly recognised as a whole-organ disorder affecting tissues in the entire knee joint, such as the meniscus and synovium (Hayashi, Guermazi, & Hunter, 2011). Its clinical presentation is heterogeneous, with typical symptoms including pain, stiffness and movement restriction.

Classification Criteria For Early Knee Osteoarthritis: A Review Article

“…Also, Lee et al point out MRI notable specifity (82 %) and moderate sensi-tivity (61 %) in OA detection. Furthermore, MRI can quantify early degenerative cartilage changes in symptomatic patients [28].…”

The use of plain radiography in diagnosing osteoarthritis: A systematic review and time trend analysis

“…Previous systematic reviews of OA guidelines focussed on management or focussed on specific joint (Kinds et al, 2011;Lee et al, 2021;Pencharz et al, 2001;Zhang et al, 2007). A recent review on the role of imaging in knee OA searched PubMed for published clinical guidelines, which only identified four guidelines (Lee et al, 2021). The current study included an extensive search of six bibliographic databases, four health improvement and guideline databases as well as a hand search of nine professional organisations' websites for guidelines across all OA sites except the spine and temporomandibular joint.…”

“…Previous systematic reviews of OA guidelines focussed on management or focussed on specific joint (Kinds et al, 2011;Lee et al, 2021;Pencharz et al, 2001;Zhang et al, 2007). A recent review on the role of imaging in knee OA searched PubMed for published clinical guidelines, which only identified four guidelines (Lee et al, 2021).…”

“…Previous reviews of OA guidelines have either concentrated on treatment (Nelson et al, 2014;Pencharz et al, 2001;Zhang et al, 2007), were specific to a single joint (Lee et al, 2021), pre-date the publication of several prominent national OA guidelines (Misso et al, 2008), or only include guidelines published in journals (Lee et al, 2021).…”

Machine Learning Based Texture Analysis of Patella from X-Rays for Detecting Patellofemoral Osteoarthritis

“…Osteoarthritis that occur at the PF joint, patellofemoral osteoarthritis (PFOA), is highly prevalent and clinically important yet still under-investigated [3]. For instance, there are clear diagnostic guidelines for tibiofemoral (TF) joint OA ( [4,5,6,7]). Often these guidelines involve the use of well-validated radiographic grading systems for evaluating the severity of TFOA, such as Kellgren and Lawrence (KL) grading system [8] and Osteoarthritis Research Society International (OARSI) standardized atlas [4].…”