Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Clinical Examination Findings of the Painful OA Knee and Correlation with MRI Abnormalities
Wenham1, C.Y., Grainger2, A., Hensor1, E.M, Maciewicz3, R.A., Waterton3, J.C., Conaghan4, P.
Multiple clinical examination findings are common when examining the painful OA knee yet there is little literature on correlation with MR imaging. This study examined the relationship between compartment specific clinical findings and associated MR abnormalities.
This was a cross-sectional study of people with painful, ACR OA knee. Detailed examination of the most painful knee was recorded within 48 hrs of 1.5 T contrast enhanced MR imaging of the knee. Logistic regression controlling for BMI, disease duration and gender was used to assess any association.
123 subjects were included. 64 (52%) women, mean age 63.4, mean pain VAS 61.3 mm. Crepitus was present in the patellofemoral (PF) compartment in 85 subjects (69%), lateral compartment in 39 (32%) and medial compartment in 44 (35%). 71 subjects (58%) had tenderness on PF compression, 101 (82%) medial joint line tenderness and 64 (52%) lateral joint line tenderness. 23 (19%) had medial knee pain on knee flexion and 50 (41%) medial pain with the joint held in maximal flexion.
At least one site with complete cartilage loss in the medial compartment was associated with medial crepitus (OR 2.15 (0.984.73) p=0.056). Lateral compartment crepitus was significantly associated with moderate-severe osteophytosis (OR 4.4 (1.689.69) p=0.02). Lateral compartment cartilage damage was uncommon but was associated with increased odds of lateral crepitus. Medial joint line tenderness was more common in those with a higher medial synovitis score (OR 2.12 (0.746.03) p=0.16). There was no association between lateral joint line tenderness and lateral synovitis scores (1.03 (0.462.28) p= 0.95) or between tenderness on PF compression and infrapatellar synovitis (0.74 (0.331.68) p=0.48). Greater area/thickness of cartilage loss and >1 site of complete cartilage loss were associated with greater odds of medial or lateral joint line tenderness or tenderness on PF compression (not statistically significant). Medial knee pain on knee flexion was significantly associated with medial synovitis (OR 3.23 (1.178.89) p=0.023). Medial knee pain with the joint held in maximal flexion was associated with medial MR findings of >75% area cartilage loss (2.61 (1.165.89) p=0.021), full thickness cartilage loss (3.07 (1.337.0) p=0.009) and medial meniscal maceration (2.80 (1.26.52) p=0.017).
This was a hypothesis generating dataset. Most examination findings did not correlate with specific pathologies. Crepitus was significantly associated with moderate-severe osteophytosis and was more common in those with complete cartilage loss. Compartment-specific tenderness was also associated with cartilage loss, but not significantly with synovitis. Medial compartment synovitis was significantly associated with medial pain both on knee flexion and with the knee held in maximal flexion.
To cite this abstract, please use the following information:
Wenham, C.Y., Grainger, A., Hensor, E.M, Maciewicz, R.A., Waterton, J.C., Conaghan, P.; Clinical Examination Findings of the Painful OA Knee and Correlation with MRI Abnormalities [abstract]. Arthritis Rheum 2009;60 Suppl 10 :208