Subchondral sclerosis8/9/2023 A substantial volume of synovitis in suprapatellar, infrapatellar and intercondylar regions considerably increases the risk for incident radiographic knee OA. The advent of MRI has underlined the pathogenic role of both synovitis and the subchondral bone tissue in OA. Inflammatory symptoms such as joint effusion or articular stiffness are common in OA and synovial inflammation detected by sonography occurs in more than half of the patients with early OA. These include muscle, ligaments, entheses, synovial tissue and the subchondral bone. Instead of being a pure cartilage disorder, OA is now considered as a whole-joint disease that affects various anatomical structures in and around the joint capsule. While mechanical overload, malalignment or joint instability frequently underlie OA in the lower extremity, metabolic factors such as hypercholesterolaemia and genetic predisposition seem to play a larger role in hand or facet joint OA. Due to substantial anatomical and biomechanical differences, OA is a highly joint-specific disorder. One reason for this is the heterogeneity of OA and its complex pathogenesis. Arthroplasty has been a major breakthrough in the treatment of advanced OA, yet a non-invasive disease-modifying treatment notably for early or intermediate OA stages is lacking. OA is a major socioeconomic health burden leading to chronic pain and disability. In OA, synovitis triggers osteoclastogenesis, pannus formation and increases adherence of synovial tissue to cartilage.Ĭhronic mechanical impairment in combination with metabolic dysregulation is a common trigger of subchondral bone changes and osteophytosis. doi:10.1016/j.joca.2011.05.Both synovitis and subchondral bone remodelling are actively involved in OA and often precede cartilage damage. Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Hunter DJ, Guermazi A, Lo GH, Grainger AJ, Conaghan PG, Boudreau RM, Roemer FW. The diagnosis of early osteoarthritis of the knee using magnetic resonance imaging. Should all elective knee radiographs requested by general practitioners be performed weight-bearing?. Alvin Chen, Joshua Balogun-Lynch, Kavita Aggarwal, Elizabeth Dick, Chinmay M Gupte. Weight-bearing radiography in osteoarthritis of the knee. (2016) Clinical Orthopaedics and Related Research®. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Fontboté R C, Nemtala U F, Contreras O O, Guerrero R. Knee osteoarthritis diagnosis, treatment and associated factors of progression: part II. Radiographic Evaluation of Arthritis: Degenerative Joint Disease and Variations. Osteoarthritis of the Knee: Comparison of MR Imaging Findings with Radiographic Severity Measurements and Pain in Middle-Aged Women. Osteoarthritis of the Knee: Association Between Clinical Features and MR Imaging Findings. Other causes of degenerative joint disease, for example: Unicompartmental joint replacement may be considered in some institutions for cases where the disease is predominantly isolated to a single joint compartment. Total knee joint replacement is effective. However, patients will often eventually require joint replacement. Non-operative management involves simple analgesia and weight loss. Subchondral bone marrow edema and/or cystsĬartilaginous defects (partial or full-thickness) The following features are seen additionally on MRI 1,10:Įffusion and synovial thickening / synovitis The initial study of any patient with suspicion of knee osteoarthritis should include a Rosenberg view, a PA radiograph with weight-bearing and 45 degrees of flexion, which is more sensitive to detect joint space narrowing 5. Plain radiographs are the workhorse of imaging including follow-up, although there is a poor correlation between radiographic findings and clinical symptoms 1,2. Weight-bearing radiographs will demonstrate more joint space narrowing than non-weight-bearing radiographs, hence affecting the radiographic severity 7,8Īltered shape of the femoral condyles and tibial plateau Usually asymmetric, typically of the medial tibiofemoral compartment, and/or patellofemoral compartment 3 The hallmarks of knee osteoarthritis are the same for most other joints 6: The medial femorotibial joint compartment is more commonly affected and often more severe compared to the lateral 2. In the community, it is estimated to affect ~12.5% of patients >45 years 8. Knee OA is very common and is the most common joint disease in the elderly. Kellgren-Lawrence grade 2 or less on radiographsĪrthroscopic cartilage lesion and/or OA-related MRI findings such as subchondral bone marrow lesions and/or cartilage and meniscal degeneration The term early osteoarthritis of the knee has been proposed and has been defined as meeting three main criteria 9:
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