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TOPLINE:

Ultrasonography (US)-identified features like osteophytes, effusion, meniscal extrusion, cartilage damage, calcium crystals, and popliteal cysts were associated with knee symptoms, radiographic knee osteoarthritis (KOA), and symptomatic KOA. The US-guided definition showed an area under the curve of 0.76 for diagnosing KOA.

METHODOLOGY:

• Researchers analyzed associations of features of KOA on US with patient-reported symptoms and radiographic KOA in a community-based cohort study in the southeastern United States from 2019 to 2024.
• They included 861 participants (mean age, 55 years; 34% men; mean body mass index, 33) with 1711 knees who underwent US and radiographic imaging to assess KOA features, along with completing questionnaires and physical exams.
• Outcomes included self-reported knee symptoms of pain, aching, or stiffness, scored from none to severe for any knee. They defined radiographic KOA as Kellgren-Lawrence Grade ≥ 2 and symptomatic KOA as a combination of pain, aching, or stiffness and radiographic KOA.
• Diagnostic accuracy was evaluated by comparing six US definitions with a radiographic definition of KOA, which required grade ≥ 1 for both osteophytes and joint space narrowing.
• Of the analyzed knees, 51% had pain, aching, or stiffness in any knee in the past 12 months; 30% had radiographic KOA; and 21% had symptomatic KOA.

TAKEAWAY:

• Effusion and moderate to large osteophytes were associated with significantly increased odds of any and moderate or severe pain, aching, or stiffness.
• The odds of radiographic KOA were three times higher in the presence of medial and lateral osteophytes, more than twice as high with moderate or severe effusion or synovitis or cartilage damage, and three times higher when medial meniscal extrusion or definite popliteal cysts were present.
• All US-identified features, especially severe effusion or synovitis, osteophytes, cartilage damage, and definite popliteal cyst, were strongly associated with symptomatic KOA.
• Compared with radiographically defined KOA, the US-guided definition including small osteophytes and minimal cartilage thinning showed the highest sensitivity (0.81) and area under the curve (0.76), with findings validated in an external cohort.

IN PRACTICE:

"US [ultrasonography] is a valuable and accessible modality for assessment of KOA [knee osteoarthritis] features in clinical and research settings, including those with limited resources," the authors wrote.

SOURCE:

The study was led by Katherine A. Yates, MD, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill and Ohio State University, Columbus, Ohio. It was published online on February 24, 2025, in Arthritis & Rheumatology.

LIMITATIONS: 

The study's design was cross-sectional, limiting the ability to establish causality. The use of a specific protocol and scoring atlas may have limited generalizability to other populations. Radiography, while practical, does not allow comparison with more similar modalities like MRI.

DISCLOSURES:

This study was supported in part by grants from the Rheumatology Research Foundation and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. One author disclosed receiving honoraria from Medscape Education and other sources and grants, not related to this work; being a member of the board of Osteoarthritis Research Society International; and serving as an associate editor for a journal along with another author. Some authors reported financial relationships with pharmaceutical companies outside of the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.