title: Sensitivity and associations with pain and body weight of an MRI definition of knee osteoarthritis compared with radiographic Kellgren and Lawrence criteria: a population-based study in middle-aged females.
abstract: OBJECTIVE
  Is a magnetic resonance imaging (MRI) definition for tibiofemoral osteoarthritis [(TFOAMRI) (definite osteophyte and full-thickness cartilage loss (or a combination of these factors with other MRI osteoarthritis (OA) features)] more sensitive to detect structural OA compared with the Kellgren & Lawrence (K&L) grading? And which definition shows the strongest association with (1) knee pain at baseline, (2) persistent knee pain during 2-year follow-up, (3) new onset of knee pain ±2 years later, and (4) body mass index (BMI).
  
  
  METHODS
  Of 888 females of the open population Rotterdam Study, radiographs and MRI of both knees were assessed for knee OA defined by K&L ≥ 2 and TFOAMRI. Pain in or around the knee is measured at baseline and ±2 years later. GEE analyses are used for the associations.
  
  
  RESULTS
  Of 1766 knees, 77 knees (4%) were diagnosed with K&L ≥ 2, whereas 160 knees (9%) met the TFOAMRI criteria. Only 43 knees met both definitions (34 knees were graded with K&L ≥ 2 and no TFOAMRI and 117 knees met only the TFOAMRI criteria). The association between the definitions and knee pain at baseline was higher when TFOAMRI was included [TFOAMRI alone: odds ratio (OR) = 2.83 (95% confidence interval (CI): 1.84-4.36); TFOAMRI & K&L ≥ 2: OR = 6.28 (95% CI: 2.99-13.19)] than for K&L ≥ 2 alone (OR = 1.83 (95% CI: 0.63-5.32)). This was similar for the association between the definitions and persistent knee pain, and between the definitions and BMI.
  
  
  CONCLUSIONS
  TFOAMRI detects more cases of knee OA than K&L ≥ 2. Together with a better content validity and at least equal construct validity, we conclude that the TFOAMRI definition for knee OA is more sensitive in detecting structural knee OA.
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: d.schiphof@erasmusmc.nl.
authors.forename: D
authors.initials: D
authors.lastname: Schiphof
authors.affiliation: Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: e.oei@erasmusmc.nl.
authors.forename: E H G
authors.initials: EH
authors.lastname: Oei
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: a.hofman@erasmusmc.nl.
authors.forename: A
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: e.waarsing@erasmusmc.nl.
authors.forename: J H
authors.initials: JH
authors.lastname: Waarsing
authors.affiliation: Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Orthopaedics and Department of Rheumatology, UMC Utrecht, Utrecht, The Netherlands. Electronic address: H.H.Weinans@umcutrecht.nl.
authors.forename: H
authors.initials: H
authors.lastname: Weinans
authors.affiliation: Department of General Practice and Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: s.bierma-zeinstra@erasmusmc.nl.
authors.forename: S M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
mesh_terms: D018771:Arthralgia / Q000175:diagnosis*; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis*; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Knee; MRI; Osteoarthritis; Pain; Radiographic