Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA study

Osteoarthritis Cartilage. 2014 Jan;22(1):76-83. doi: 10.1016/j.joca.2013.10.007. Epub 2013 Nov 1.


Objective: To determine which subregions of the knee joint have a high prevalence of pre-radiographic osteoarthritic changes, i.e., cartilage damage and osteophytes that can only be detected by magnetic resonance imaging (MRI), in radiographically normal knees.

Methods: Institutional Review Board approval and written informed consent from all participants was obtained. Data was collected from a community cohort in Framingham, MA, involving people aged 50-79. Participants underwent weight-bearing posteroanterior and lateral knee radiography with the fixed-flexion protocol, and 1.5 T MRI. Knees without radiographic osteoarthritis (Kellgren Lawrence grade 0 for the tibiofemoral joint and absence of any osteophytes or joint space narrowing in the patellofemoral joint) were included. The knee joint was divided into 14 subregions for cartilage and 16 subregions for osteophytes, and prevalence and severity of cartilage damage (grade 0-6) and osteophytes (grade 0-7) were semiquantitatively assessed using the Whole Organ Magnetic Resonance Imaging Score (WORMS).

Results: The mean age of 696 participants was 62.3 ± 8.4 years, and the mean body mass index was 27.9 ± 5.1 kg/m2. Women comprised 55.2% of the study sample (384/696). Prevalence of cartilage damage (grade ≥2) was 47.7% (332/696) in the medial patellar and 29.9% (208/696) in patellar lateral (PL) subregions, and 24.0% (167/696) in femoral medial anterior (FMA) and 26.5% (184/696) in femoral medial central (FMC) subregions. Prevalence of osteophytes (grade ≥2) was highest at 60.8% (423/696) in the medial femoral posterior subregion, followed by 34.0% (237/696) in PL and 24.6% (171/696) in patellar medial (PM) subregions. For all other subregions, prevalence of these lesions was lower than the aforementioned percentages.

Conclusion: MRI-detected cartilage damage and osteophytes are highly prevalent in the medial patellofemoral and medial posterior tibiofemoral joints in radiographically normal knees in persons aged 50-79.

Keywords: Cartilage; Knee; Osteoarthritis; Osteophyte; Patella.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Body Mass Index
  • Early Diagnosis
  • Female
  • Femur / diagnostic imaging
  • Femur / pathology*
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / pathology*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / pathology*
  • Osteophyte / pathology
  • Patella / diagnostic imaging
  • Patella / pathology*
  • Radiography
  • Severity of Illness Index