Considering the plethora of imaging protocols, joint-specific orientations, and potential artifacts, the design and interpretation of MR imaging examination is difficult. Like a physical examination, these considerations must be tailored to the specific tissue, joint, and clinical question under consideration. Shortcomings of MR imaging include the lack of consensus among radiologists with respect to which protocols best image articular joints. To date, few prospective studies have been undertaken to assess osteoarthritis by MR imaging. Diagnostic imaging is central to staging the severity of osteoarthritis and assessing the efficacy of therapeutic osteoarthritis. Plain film radiography is insensitive for identifying early changes of osteoarthritis. Tailored MR imaging, producing high spatial and or contrast resolution images, is proving to be an important tool in the early detection and surveillance of osteoarthritis progression. Future therapeutic techniques, such as chondrocyte transplantation, use of growth factors, or cartilage protease inhibitors requires high resolution and volumetric MR imaging studies for accurate identification of focal articular cartilage defects and generalized cartilage loss. Creation of cartilage models by three-dimensional MR image rendering may be helpful for preoperative planning of orthopedic surgical procedures in advanced cases of osteoarthritis. More work needs to be done in high resolution and volumetric MR imaging of articular cartilage. Given the availability of new disease-modifying treatments designed to prevent, delay the progression of, or reverse osteoarthritis, additional prospective MR imaging studies need to be undertaken to improve the reproducibility of MR imaging as a primary outcome measure in the evaluation of osteoarthritis. Interinstitutional standardization of specific MR imaging magnet strengths, surface coils, joint orientations, sequences used, scoring systems and quality assurance methodologies are needed to establish the reproducibility of MR imaging and interpretation for assessment of patients with osteoarthritis.