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Early osteoarthritis of the knee

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

There is an increasing awareness on the importance in identifying early phases of the degenerative processes in knee osteoarthritis (OA), the crucial period of the disease when there might still be the possibility to initiate treatments preventing its progression. Early OA may show a diffuse and ill-defined involvement, but also originate in the cartilage surrounding a focal lesion, thus necessitating a separate assessment of these two entities. Early OA can be considered to include a maximal involvement of 50 % of the cartilage thickness based on the macroscopic ICRS classification, reflecting an OARSI grade 4. The purpose of this paper was to provide an updated review of the current status of the diagnosis and definition of early knee OA, including the clinical, radiographical, histological, MRI, and arthroscopic definitions and biomarkers. Based on current evidence, practical classification criteria are presented. As new insights and technologies become available, they will further evolve to better define and treat early knee OA.

Level of evidence IV.

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References

  1. Adams ME, Brandt KD (1991) Hypertrophic repair of canine articular cartilage in osteoarthritis after anterior cruciate ligament transection. J Rheumatol 18(3):428–435

    CAS  PubMed  Google Scholar 

  2. Arendt EA, Dahm DL, Dejour D, Fithian DC (2014) Patellofemoral joint: from instability to arthritis. Instr Course Lect 63:355–368

    PubMed  Google Scholar 

  3. Baert IA, Jonkers I, Staes F, Luyten FP, Truijen S, Verschueren SM (2012) Gait characteristics and lower limb muscle strength in women with early and established knee osteoarthritis. Clin Biomech (Bristol, Avon) 28(1):40–47

    Article  Google Scholar 

  4. Batsis JA, Germain CM, Vasquez E, Zbehlik AJ, Bartels SJ (2015) Physical activity predicts higher physical function in older adults: the osteoarthritis initiative. J Phys Act Health. doi:10.1123/jpah.2014-0531

    PubMed  Google Scholar 

  5. Bauer DC, Hunter DJ, Abramson SB, Attur M, Corr M, Felson D, Heinegard D, Jordan JM, Kepler TB, Lane NE, Saxne T, Tyree B, Kraus VB (2006) Classification of osteoarthritis biomarkers: a proposed approach. Osteoarthr Cartil 14(8):723–727

    Article  CAS  PubMed  Google Scholar 

  6. Bijlsma JW, Berenbaum F, Lafeber FP (2011) Osteoarthritis: an update with relevance for clinical practice. Lancet 377(9783):2115–2126

    Article  PubMed  Google Scholar 

  7. Blanco FJ (2014) Osteoarthritis year in review 2014: we need more biochemical biomarkers in qualification phase. Osteoarthr Cartil 22(12):2025–2032

    Article  PubMed  Google Scholar 

  8. Brandt KD, Fife RS, Braunstein EM, Katz B (1991) Radiographic grading of the severity of knee osteoarthritis: relation of the Kellgren and Lawrence grade to a grade based on joint space narrowing, and correlation with arthroscopic evidence of articular cartilage degeneration. Arthritis Rheum 34(11):1381–1386

    Article  CAS  PubMed  Google Scholar 

  9. Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, Pols HA, Bierma-Zeinstra SM (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56(4):1204–1211

    Article  CAS  PubMed  Google Scholar 

  10. Case R, Thomas E, Clarke E, Peat G (2015) Prodromal symptoms in knee osteoarthritis: a nested case-control study using data from the osteoarthritis initiative. Osteoarthr Cartil 23(7):1083–1089

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Chan WP, Huang GS, Hsu SM, Chang YC, Ho WP (2008) Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain. Skelet Radiol 37(10):917–922

    Article  Google Scholar 

  12. Chiba K, Ito M, Osaki M, Uetani M, Shindo H (2011) In vivo structural analysis of subchondral trabecular bone in osteoarthritis of the hip using multi-detector row CT. Osteoarthr Cartil 19(2):180–185

    Article  CAS  PubMed  Google Scholar 

  13. Crawford DC, Safran MR (2006) Osteochondritis dissecans of the knee. J Am Acad Orthop Surg 14(2):90–100

    Article  PubMed  Google Scholar 

  14. Culvenor AG, Collins NJ, Guermazi A, Cook JL, Vicenzino B, Khan KM, Beck N, van Leeuwen J, Crossley KM (2015) Early knee osteoarthritis is evident one year following anterior cruciate ligament reconstruction: a magnetic resonance imaging evaluation. Arthritis Rheumatol 67(4):946–955

    Article  CAS  PubMed  Google Scholar 

  15. Desrochers J, Amrein MW, Matyas JR (2013) Microscale surface friction of articular cartilage in early osteoarthritis. J Mech Behav Biomed Mater 25:11–22

    Article  CAS  PubMed  Google Scholar 

  16. Dieppe P, Cushnaghan J, Young P, Kirwan J (1993) Prediction of the progression of joint space narrowing in osteoarthritis of the knee by bone scintigraphy. Ann Rheum Dis 52(8):557–563

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Felson DT, Hodgson R (2014) Identifying and treating preclinical and early osteoarthritis. Rheum Dis Clin N Am 40(4):699–710

    Article  Google Scholar 

  18. Felson DT, Nevitt MC, Yang M, Clancy M, Niu J, Torner JC, Lewis CE, Aliabadi P, Sack B, McCulloch C, Zhang Y (2008) A new approach yields high rates of radiographic progression in knee osteoarthritis. J Rheumatol 35(10):2047–2054

    PubMed  PubMed Central  Google Scholar 

  19. Felson DT, Niu J, Guermazi A, Sack B, Aliabadi P (2011) Defining radiographic incidence and progression of knee osteoarthritis: suggested modifications of the Kellgren and Lawrence scale. Ann Rheum Dis 70(11):1884–1886

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fingleton C, Smart K, Moloney N, Fullen BM, Doody C (2015) Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil 23(7):1043–1056

    Article  CAS  PubMed  Google Scholar 

  21. Funck-Brentano T, Cohen-Solal M (2011) Crosstalk between cartilage and bone: when bone cytokines matter. Cytokine Growth Factor Rev 22(2):91–97

    Article  CAS  PubMed  Google Scholar 

  22. Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, Carr AJ (2015) Osteoarthritis. Lancet 386(9991):376–387

    Article  CAS  PubMed  Google Scholar 

  23. Goldring MB, Berenbaum F (2015) Emerging targets in osteoarthritis therapy. Curr Opin Pharmacol 22:51–63

    Article  CAS  PubMed  Google Scholar 

  24. Goldring MB, Marcu KB (2009) Cartilage homeostasis in health and rheumatic diseases. Arthritis Res Ther 11(3):224

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hensor EM, Dube B, Kingsbury SR, Tennant A, Conaghan PG (2014) Toward a clinical definition of early osteoarthritis: onset of patient-reported knee pain begins on stairs. Data from the osteoarthritis initiative. Arthritis Care Res (Hoboken) 67(1):40–47

    Article  Google Scholar 

  26. Hutton CW, Higgs ER, Jackson PC, Watt I, Dieppe PA (1986) 99mTc HMDP bone scanning in generalised nodal osteoarthritis. I. Comparison of the standard radiograph and four hour bone scan image of the hand. Ann Rheum Dis 45(8):617–621

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Jones LD, Bottomley N, Harris K, Jackson W, Price AJ, Beard DJ (2014) The clinical symptom profile of early radiographic knee arthritis: a pain and function comparison with advanced disease. Knee Surg Sports Traumatol Arthrosc 24(1):161–168

    Article  PubMed  Google Scholar 

  28. Kapoor M, Martel-Pelletier J, Lajeunesse D, Pelletier JP, Fahmi H (2010) Role of proinflammatory cytokines in the pathophysiology of osteoarthritis. Nat Rev Rheumatol 7(1):33–42

    Article  PubMed  Google Scholar 

  29. Karlsen TA, Jakobsen RB, Mikkelsen TS, Brinchmann JE (2013) microRNA-140 targets RALA and regulates chondrogenic differentiation of human mesenchymal stem cells by translational enhancement of SOX9 and ACAN. Stem Cells Dev 23(3):290–304

    Article  PubMed  Google Scholar 

  30. Kraus VB (2011) Osteoarthritis year 2010 in review: biochemical markers. Osteoarthr Cartil 19(4):346–353

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kraus VB, Feng S, Wang S, White S, Ainslie M, Graverand MP, Brett A, Eckstein F, Hunter DJ, Lane NE, Taljanovic MS, Schnitzer T, Charles HC (2013) Subchondral bone trabecular integrity predicts and changes concurrently with radiographic and magnetic resonance imaging-determined knee osteoarthritis progression. Arthritis Rheum 65(7):1812–1821

    Article  PubMed  PubMed Central  Google Scholar 

  32. Li B, Aspden RM (1997) Mechanical and material properties of the subchondral bone plate from the femoral head of patients with osteoarthritis or osteoporosis. Ann Rheum Dis 56(4):247–254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Lotz M, Martel-Pelletier J, Christiansen C, Brandi ML, Bruyere O, Chapurlat R, Collette J, Cooper C, Giacovelli G, Kanis JA, Karsdal MA, Kraus V, Lems WF, Meulenbelt I, Pelletier JP, Raynauld JP, Reiter-Niesert S, Rizzoli R, Sandell LJ, Van Spil WE, Reginster JY (2014) Republished: value of biomarkers in osteoarthritis: current status and perspectives. Postgrad Med J 90(1061):171–178

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L (2011) Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20(3):401–406

    Article  PubMed  Google Scholar 

  35. Madry H, Luyten FP, Facchini A (2012) Biological aspects of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 30(3):407–422

    Article  Google Scholar 

  36. Muraki S, Akune T, En-Yo Y, Yoshida M, Suzuki T, Yoshida H, Ishibashi H, Tokimura F, Yamamoto S, Tanaka S, Nakamura K, Kawaguchi H, Oka H, Yoshimura N (2015) Joint space narrowing, body mass index, and knee pain: the ROAD study (OAC1839R1). Osteoarthr Cartil 23(6):874–881

    Article  CAS  PubMed  Google Scholar 

  37. Neogi T, Bowes MA, Niu J, De Souza KM, Vincent GR, Goggins J, Zhang Y, Felson DT (2013) Magnetic resonance imaging-based three-dimensional bone shape of the knee predicts onset of knee osteoarthritis: data from the osteoarthritis initiative. Arthritis Rheum 65(8):2048–2058

    Article  PubMed  PubMed Central  Google Scholar 

  38. Neu CP, Reddi AH, Komvopoulos K, Schmid TM, Di Cesare PE (2010) Increased friction coefficient and superficial zone protein expression in patients with advanced osteoarthritis. Arthritis Rheum 62(9):2680–2687

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Niemeyer P, Andereya S, Angele P, Ateschrang A, Aurich M, Baumann M, Behrens P, Bosch U, Erggelet C, Fickert S, Fritz J, Gebhard H, Gelse K, Gunther D, Hoburg A, Kasten P, Kolombe T, Madry H, Marlovits S, Meenen NM, Muller PE, Noth U, Petersen JP, Pietschmann M, Richter W, Rolauffs B, Rhunau K, Schewe B, Steinert A, Steinwachs MR, Welsch GH, Zinser W, Albrecht D (2013) Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: a guideline by the working group “Tissue Regeneration” of the German Society of Orthopaedic Surgery and Traumatology (DGOU). Z Orthop Unfall 151(1):38–47

    CAS  PubMed  Google Scholar 

  40. Oka H, Muraki S, Akune T, Mabuchi A, Suzuki T, Yoshida H, Yamamoto S, Nakamura K, Yoshimura N, Kawaguchi H (2008) Fully automatic quantification of knee osteoarthritis severity on plain radiographs. Osteoarthr Cartil 16(11):1300–1306

    Article  CAS  PubMed  Google Scholar 

  41. Orth P, Cucchiarini M, Wagenpfeil S, Menger MD, Madry H (2014) PTH [1-34]-induced alterations of the subchondral bone provoke early osteoarthritis. Osteoarthr Cartil 22(6):813–821

    Article  CAS  PubMed  Google Scholar 

  42. Palmer AJ, Brown CP, McNally EG, Price AJ, Tracey I, Jezzard P, Carr AJ, Glyn-Jones S (2013) Non-invasive imaging of cartilage in early osteoarthritis. Bone Joint J 95(6):738–746

    Article  PubMed  Google Scholar 

  43. Pritzker KP, Gay S, Jimenez SA, Ostergaard K, Pelletier JP, Revell PA, Salter D, van den Berg WB (2006) Osteoarthritis cartilage histopathology: grading and staging. Osteoarthr Cartil 14(1):13–29

    Article  CAS  PubMed  Google Scholar 

  44. Radin EL, Paul IL, Tolkoff MJ (1970) Subchondral bone changes in patients with early degenerative joint disease. Arthritis Rheum 13(4):400–405

    Article  CAS  PubMed  Google Scholar 

  45. Reijman M, Pols HA, Bergink AP, Hazes JM, Belo JN, Lievense AM, Bierma-Zeinstra SM (2007) Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study. Ann Rheum Dis 66(2):158–162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Ritter SY, Collins J, Krastins B, Sarracino D, Lopez M, Losina E, Aliprantis AO (2014) Mass spectrometry assays of plasma biomarkers to predict radiographic progression of knee osteoarthritis. Arthritis Res Ther 16(5):456

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ryd L, Brittberg M, Eriksson K, Jurvelin JS, Lindahl A, Marlovits S, Moller P, Richardson JB, Steinwachs M, Zenobi-Wong M (2015) Pre-osteoarthritis: definition and diagnosis of an elusive clinical entity. Cartilage 6(3):156–165

    Article  PubMed  Google Scholar 

  48. Saberi Hosnijeh F, Runhaar J, van Meurs JB, Bierma-Zeinstra SM (2015) Biomarkers for osteoarthritis: can they be used for risk assessment? A systematic review. Maturitas 82(1):36–49

    Article  CAS  Google Scholar 

  49. Sakata R, McNary SM, Miyatake K, Lee CA, Van den Bogaerde JM, Marder RA, Reddi AH (2015) Stimulation of the superficial zone protein and lubrication in the articular cartilage by human platelet-rich plasma. Am J Sports Med 43(6):1467–1473

    Article  PubMed  Google Scholar 

  50. Saris DB, Dhert WJ, Verbout AJ (2003) Joint homeostasis. The discrepancy between old and fresh defects in cartilage repair. J Bone Joint Surg Br 85(7):1067–1076

    Article  CAS  PubMed  Google Scholar 

  51. Scanzello CR, Goldring SR (2012) The role of synovitis in osteoarthritis pathogenesis. Bone 51(2):249–257

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Schinhan M, Gruber M, Vavken P, Dorotka R, Samouh L, Chiari C, Gruebl-Barabas R, Nehrer S (2012) Critical-size defect induces unicompartmental osteoarthritis in a stable ovine knee. J Orthop Res 30(2):214–220

    Article  PubMed  Google Scholar 

  53. Steinwachs MR, Engebretsen L, Brophy RH (2012) Scientific evidence base for cartilage injury and repair in the athlete. Cartilage 3(1 Suppl):11S–17S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Thorstensson CA, Andersson ML, Jonsson H, Saxne T, Petersson IF (2009) Natural course of knee osteoarthritis in middle-aged subjects with knee pain: 12-year follow-up using clinical and radiographic criteria. Ann Rheum Dis 68(12):1890–1893

    Article  CAS  PubMed  Google Scholar 

  55. Tsezou A (2014) Osteoarthritis year in review 2014: genetics and genomics. Osteoarthr Cartil 22(12):2017–2024

    Article  CAS  PubMed  Google Scholar 

  56. Van Spil WE, Welsing PM, Bierma-Zeinstra SM, Bijlsma JW, Roorda LD, Cats HA, Lafeber FP (2015) The ability of systemic biochemical markers to reflect presence, incidence, and progression of early-stage radiographic knee and hip osteoarthritis: data from CHECK. Osteoarthr Cartil 23(8):1388–1397

    Article  PubMed  Google Scholar 

  57. Vincent HK, Heywood K, Connelly J, Hurley RW (2012) Obesity and weight loss in the treatment and prevention of osteoarthritis. PM R 4(5 Suppl):S59–S67

    Article  PubMed  PubMed Central  Google Scholar 

  58. Wada M, Imura S, Baba H, Shimada S (1996) Knee laxity in patients with osteoarthritis and rheumatoid arthritis. Br J Rheumatol 35(6):560–563

    Article  CAS  PubMed  Google Scholar 

  59. Xu L, Polur I, Servais JM, Hsieh S, Lee PL, Goldring MB, Li Y (2011) Intact pericellular matrix of articular cartilage is required for unactivated discoidin domain receptor 2 in the mouse model. Am J Pathol 179(3):1338–1346

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Zeggini E, Panoutsopoulou K, Southam L, Rayner NW, Day-Williams AG, Lopes MC, Boraska V, Esko T, Evangelou E, Hoffman A, Houwing-Duistermaat JJ, Ingvarsson T, Jonsdottir I, Jonnson H, Kerkhof HJ, Kloppenburg M, Bos SD, Mangino M, Metrustry S, Slagboom PE, Thorleifsson G, Raine EV, Ratnayake M, Ricketts M, Beazley C, Blackburn H, Bumpstead S, Elliott KS, Hunt SE, Potter SC, Shin SY, Yadav VK, Zhai G, Sherburn K, Dixon K, Arden E, Aslam N, Battley PK, Carluke I, Doherty S, Gordon A, Joseph J, Keen R, Koller NC, Mitchell S, O’Neill F, Paling E, Reed MR, Rivadeneira F, Swift D, Walker K, Watkins B, Wheeler M, Birrell F, Ioannidis JP, Meulenbelt I, Metspalu A, Rai A, Salter D, Stefansson K, Stykarsdottir U, Uitterlinden AG, van Meurs JB, Chapman K, Deloukas P, Ollier WE, Wallis GA, Arden N, Carr A, Doherty M, McCaskie A, Willkinson JM, Ralston SH, Valdes AM, Spector TD, Loughlin J (2012) Identification of new susceptibility loci for osteoarthritis (arcOGEN): a genome-wide association study. Lancet 380(9844):815–823

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center of Experimental Orthopaedics, Saarland University, Kirrberger Strasse 100, Building 37-38, 66421, Homburg/Saar, Germany

    Henning Madry

  2. Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37-38, 66421, Homburg/Saar, Germany

    Henning Madry

  3. NABI Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy

    Elizaveta Kon

  4. Dipartimento di Ortopedia, Responsabile di Struttura Semplice di Traumatologia dello, Sport Knee Surgery and Sports Traumatology, Ospedale Sacro Cuore - Don Calabria, Via Don, Sempreboni, 5, 37024, Negrar, Verona, Italy

    Vincenzo Condello

  5. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Giuseppe M. Peretti

  6. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    Giuseppe M. Peretti

  7. SportClinic Zürich, Klinik Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland

    Matthias Steinwachs

  8. Service de Chirurgie Orthopédique, Centre de L‘Appareil Locomoteur, de Médecine du Sport et de Prévention, Centre Hospitalier de Luxembourg-Clinique d’Eich and Sports Medicine Research Laboratory, Luxembourg Institute of Health, 78, rue d’Eich, 1460, Luxembourg, Luxembourg

    Romain Seil

  9. Centro di Eccellenza per L’attività Ortopedica, Reumatologica e Riabilitativa, L’Istituto Ortopedico Gaetano Pini è un’Azienda Ospedaliera di rilievo nazionale, P.zza A. Ferrari, 1, 20122, Milan, Italy

    Massimo Berruto

  10. Department of Orthopedic Surgery, Oslo University Hospital and Oslo Sports Trauma Research Center, 0407, Oslo, Norway

    Lars Engebretsen

  11. Biomechanics Laboratory, II Orthopaedics and Traumatology Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy

    Giuseppe Filardo

  12. Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany

    Peter Angele

  13. Sporthopaedicum Regensburg, Hildegard von Bingen Strasse 1, 93053, Regensburg, Germany

    Peter Angele

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  1. Henning Madry
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  2. Elizaveta Kon
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  3. Vincenzo Condello
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Correspondence to Henning Madry.

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Madry, H., Kon, E., Condello, V. et al. Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 24, 1753–1762 (2016). https://doi.org/10.1007/s00167-016-4068-3

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