Association between constant and intermittent knee pain and T2 values and cartilage thickness: data from the osteoarthritis initiative

Maximilian T Löffler; Gabby B Joseph; John A Lynch; Nancy E Lane; Valentina Pedoia; Sharmila Majumdar; Michael Nevitt; Charles McCulloch; Thomas M Link

doi:10.1186/s13075-025-03667-9

Association between constant and intermittent knee pain and T2 values and cartilage thickness: data from the osteoarthritis initiative

Arthritis Res Ther. 2025 Oct 22;27(1):196. doi: 10.1186/s13075-025-03667-9.

Authors

Maximilian T Löffler^{1

2

3}, Gabby B Joseph⁴, John A Lynch⁴, Nancy E Lane⁵, Valentina Pedoia⁴, Sharmila Majumdar⁴, Michael Nevitt⁶, Charles McCulloch⁵, Thomas M Link⁴

Affiliations

¹ Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany. m_loeffler@web.de.
² Department of Radiology and Biomedical Imaging, UCSF, 185 Berry Street, Suite 350, Lobby 6, San Francisco, CA, 94143, USA. m_loeffler@web.de.
³ Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. m_loeffler@web.de.
⁴ Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany.
⁵ Department of Medicine, Center for Musculoskeletal Health, UC Davis, Health Sacramento, CA, USA.
⁶ Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA.

Abstract

Background: We investigated whether cartilage composition and thickness and its change over time were associated with future intermittent and constant knee pain.

Methods: Osteoarthritis Initiative participants with 3T MRI scans from baseline to 36-month visits were selected. Outcomes were Intermittent and Constant Osteoarthritis Pain (ICOAP) scores in the right knee at the 48-month visit (0 to 100 = highest pain). We measured T₂ values and cartilage thickness in 5 regions in the right knee from baseline to 36-months using deep-learning-based segmentation. Associations between baseline and change in cartilage biomarkers with pain scores were tested using adjusted logistic and linear regression models.

Results: Of 3780 included participants, 1042(28%) had symptomatic knee OA in any knee at baseline. At 48 months, 1671(44%) had intermittent and 265(7%) constant pain in the right knee. Odds for having intermittent knee pain increased with longer baseline T₂ values in medial and lateral femoral cartilage (OR[95%CI]: 1.05[1.02–1.08] and 1.06[1.03–1.09] for 1 ms longer) and thinner baseline patellar cartilage (0.65[0.53–0.81] for 1 mm thicker). Greater annual rates of patellar cartilage thinning were associated with higher odds of constant knee pain (93.4[7.66–1139] for 1 mm/yr greater). Among those with knee pain, greater annual rates of increase in medial and lateral tibial cartilage T₂ led to more intermittent knee pain (percent change[95%CI]: 8.02[2.87–13.4] and 7.85[3.39–12.5] for 1 ms/yr greater). Thicker lateral tibial cartilage at baseline led to less constant knee pain (beta coeff.[95%CI]: -11.8[-19.8–3.76] for 1 mm thicker).

Conclusions: Impaired femoral cartilage composition, indicated by longer T₂ values, preceded intermittent knee pain found in early-stage OA. Constant knee pain characteristic for late-stage OA was related to greater cartilage thickness loss.

Supplementary Information: The online version contains supplementary material available at 10.1186/s13075-025-03667-9.

Keywords: Cartilage T2 values; Cartilage thickness; Compositional MRI; Knee osteoarthritis; Knee pain.