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Open Access Research article

Biomechanical factors and physical examination findings in osteoarthritis of the knee: associations with tissue abnormalities assessed by conventional radiography and high-resolution 3.0 Tesla magnetic resonance imaging

Jesper Knoop1*, Joost Dekker23, Jan-Paul Klein4, Marike van der Leeden12, Martin van der Esch1, Dick Reiding5, Ramon E Voorneman5, Martijn Gerritsen5, Leo D Roorda1, Martijn PM Steultjens6 and Willem F Lems57

Author affiliations

1 Amsterdam Rehabilitation Research Center - Reade, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, the Netherlands

2 Department of Rehabilitation Medicine/EMGO, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands

3 Department of Psychiatry, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands

4 Department of Radiology, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands

5 Jan van Breemen Research Institute - Reade, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, the Netherlands

6 School of Health and Life Sciences, Institute for Applied Health Research, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK

7 Department of Rheumatology, VU University Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands

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Citation and License

Arthritis Research & Therapy 2012, 14:R212  doi:10.1186/ar4050

Published: 5 October 2012

Abstract

Introduction

We aimed to explore the associations between knee osteoarthritis (OA)-related tissue abnormalities assessed by conventional radiography (CR) and by high-resolution 3.0 Tesla magnetic resonance imaging (MRI), as well as biomechanical factors and findings from physical examination in patients with knee OA.

Methods

This was an explorative cross-sectional study of 105 patients with knee OA. Index knees were imaged using CR and MRI. Multiple features from CR and MRI (cartilage, osteophytes, bone marrow lesions, effusion and synovitis) were related to biomechanical factors (quadriceps and hamstrings muscle strength, proprioceptive accuracy and varus-valgus laxity) and physical examination findings (bony tenderness, crepitus, bony enlargement and palpable warmth), using multivariable regression analyses.

Results

Quadriceps weakness was associated with cartilage integrity, effusion, synovitis (all detected by MRI) and CR-detected joint space narrowing. Knee joint laxity was associated with MRI-detected cartilage integrity, CR-detected joint space narrowing and osteophyte formation. Multiple tissue abnormalities including cartilage integrity, osteophytes and effusion, but only those detected by MRI, were found to be associated with physical examination findings such as crepitus.

Conclusion

We observed clinically relevant findings, including a significant association between quadriceps weakness and both effusion and synovitis, detected by MRI. Inflammation was detected in over one-third of the participants, emphasizing the inflammatory component of OA and a possible important role for anti-inflammatory therapies in knee OA. In general, OA-related tissue abnormalities of the knee, even those detected by MRI, were found to be discordant with biomechanical and physical examination features.