Definition and classification of early osteoarthritis of the knee

  • Frank P. Luyten
  • Matteo Denti
  • Giuseppe Filardo
  • Elizaveta Kon
  • Lars EngebretsenEmail author


With the emerging interest in regenerative medicine and tissue engineering, new treatment modalities being developed for joint disorders including joint surface lesions and articular cartilage defects. The clinical outcome of these novel approaches appears rather unpredictable and is due to many reasons but definitely also linked to the patient profile. As a typical example, symptomatic articular cartilage lesions can be presented in an otherwise normal joint, or associated with several other joint tissue alterations including meniscal lesions and abnormalities of the underlying bone. The outcome of novel treatments may well be influenced by the status of the whole joint, and the potential to develop osteoarthritis. To better identify the patients at risk and responders to certain treatments, it is of use to define and most importantly classify patients with “early osteoarthritis”. Here, classification criteria for this group of patients are presented, allowing a more defined and accurate inclusion in clinical trials in the future.


Early osteoarthritis Classification Knee MRI Arthroscopy 



We want to acknowledge all the participants to the ESSKA Cartilage Committee Consensus Meeting “Early Degenerative Arthritis of the Knee: Biological solutions”, organized by Dr. Elizaveta Kon and Prof. Maurilio Marcacci (10th–11th March 2011, Bologna, Italy): Fredrik Almqvist, Laura De Girolamo, Stefano Della Villa Matej Drobnic, Joao Espregueira-Mendes, Andrea Facchini, Andreas Gomoll, Mislav Jelic, Henning Madry, Maurilio Marcacci, Joan Monllau, Giancarlo Puddu, William G. Rodkey, Niek van Dijk, Rene Verdonk, Stefano Zaffagnini.


  1. 1.
    Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the american rheumatism association. Arthritis Rheum 8:1039–1049CrossRefGoogle Scholar
  2. 2.
    Engen CN, Engebretsen L, Aroen A (2010) Knee cartilage defect patients enrolled in randomized controlled trials are not representative of patients in orthopedic practice. Cartilage 2:312–319Google Scholar
  3. 3.
    Felson DT, Lynch J, Guermazi A, Roemer FW, Niu J, McAlindon T et al (2010) Comparison of BLOKS and WORMS scoring systems part II. Longitudinal assessment of knee MRIs for osteoarthritis and suggested approach based on their performance: data from the Osteoarthritis Initiative. Osteoarthr Cartil 11:1402–1407CrossRefGoogle Scholar
  4. 4.
    Felson DT, Niu J, Guermazi A, Sack B, Aliabadi P (2011) Defining radiographic incidence and progression of knee osteoarthritis: problems with the Kellgren and Lawrence scale. Ann Rheum Dis 70:1884–1886Google Scholar
  5. 5.
    Hunter DJ, Lo GH, Gale D, Grainger AJ, Guermazi A, Conaghan PG (2008) The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston Leeds osteoarthritis knee score). Ann Rheum Dis 2:206–211CrossRefGoogle Scholar
  6. 6.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 4:494–502CrossRefGoogle Scholar
  7. 7.
    Kerkhof HJ, Meulenbelt I, Akune T, Arden NK, Aromaa A, Bierma-Zeinstra SM et al (2011) Recommendations for standardization and phenotype definitions in genetic studies of osteoarthritis: the TREAT-OA consortium. Osteoarthr Cartil 3:254–264CrossRefGoogle Scholar
  8. 8.
    Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC et al (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 10:2105–2112CrossRefGoogle Scholar
  9. 9.
    Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A et al (2010) Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 4:472–479CrossRefGoogle Scholar
  10. 10.
    Lynch JA, Roemer FW, Nevitt MC, Felson DT, Niu J, Eaton CB et al (2010) Comparison of BLOKS and WORMS scoring systems part I. Cross sectional comparison of methods to assess cartilage morphology, meniscal damage and bone marrow lesions on knee MRI: data from the osteoarthritis initiative. Osteoarthr Cartil 11:1393–1401CrossRefGoogle Scholar
  11. 11.
    Oiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L et al (2010) Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med 11:2201–2210CrossRefGoogle Scholar
  12. 12.
    Peterfy CG, Guermazi A, Zaim S, Tirman PF, Miaux Y, White D et al (2004) Whole-organ magnetic resonance imaging score (WORMS) of the knee in osteoarthritis. Osteoarthr Cartil 3:177–190CrossRefGoogle Scholar
  13. 13.
    Risberg MA, Holm I, Tjomsland O, Ljunggren E, Ekeland A (1999) Prospective study of changes in impairments and disabilities after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 7:400–412Google Scholar
  14. 14.
    Saris DB, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J et al (2009) Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 9:10S–19SCrossRefGoogle Scholar
  15. 15.
    Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y et al (2008) Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 2:235–246CrossRefGoogle Scholar
  16. 16.
    Schneider CK, Salmikangas P, Jilma B, Flamion B, Todorova LR, Paphitou A et al (2010) Challenges with advanced therapy medicinal products and how to meet them. Nat Rev Drug Discov 3:195–201CrossRefGoogle Scholar
  17. 17.
    The European Parliament and the Council of the European Union (2007) Regulation (EC) No. 1394/2007 of the European Parliament and of the Council of 13 November 2007 on advances therapy medicinal products and amending directive 2001/83/EC and regulation (EC) No 726/2004. Official J Eur UnionGoogle Scholar
  18. 18.
    The European Parliament and the Council of the European Union (2009) Commission directive 2009/120/EC of 14 September 2009 amending Directive 2001/83/EC of the European Parliament and of the Council on the Community code relating to medicinal products for human use as regards advanced therapy medicinal products. Official J Eur UnionGoogle Scholar
  19. 19.
    Van Osch GJ, Brittberg M, Dennis JE, Bastiaansen-Jenniskens YM, Erben RG, Konttinen YT et al (2009) Cartilage repair: past and future-lessons for regenerative medicine. J Cell Mol Med 5:792–810CrossRefGoogle Scholar
  20. 20.

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Frank P. Luyten
    • 1
  • Matteo Denti
    • 2
  • Giuseppe Filardo
    • 3
  • Elizaveta Kon
    • 3
  • Lars Engebretsen
    • 4
    • 5
    Email author
  1. 1.Division of Rheumatology, Laboratory for Skeletal Development and Joint DisordersKatholieke Universiteit LeuvenLeuvenBelgium
  2. 2.Knee Surgery and Sports Traumatology, IRCCS Istituto Clinico HumanitasRozzano, MilanItaly
  3. 3.Biomechanics Laboratory, III Clinic, Rizzoli Orthopaedic InstituteBolognaItaly
  4. 4.Department of Sports Medicine, Oslo Sports Trauma Research CenterNorwegian School of Sport SciencesOsloNorway
  5. 5.Department of Orthopaedic SurgeryUniversity of OsloOsloNorway

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