Skip to main content
Log in

Validity of the sonographic longitudinal sagittal image for assessment of the cartilage thickness in the knee osteoarthritis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript


We compared the validity of the sonographic longitudinal sagittal image with the suprapatellar transverse axial image for assessment of thickness of femoral cartilage in osteoarthritis (OA) patients. Fifty-one patients with knee OA were enrolled in this study. Cartilage thicknesses of medial and lateral femoral condyles were measured with longitudinal sagittal and suprapatellar transverse axial image using sonography. Fat-suppressed 3D spoiled gradient-echo magnetic resonance imaging (MRI) was also used to get the reference value. The joint space width (JSW) and Kellgren and Lawrence (K–L) grade were measured in weight-bearing anteroposterior knee radiograph. The kappa and intraclass correlation coefficient (ICC) were used to determine inter- and intra-observer agreement of the ultrasound sonography (US) measurements. In medial femoral condyle, the opportunity to obtain cartilage thickness was increased significantly using the longitudinal US scan as compared with tansverse scan (48 cases vs. 36 cases, p < 0.05). There was a good correlation between longitudinal US scan and MRI in the maximum and minimum cartilage thicknesses of medial condyle (r = 0.568; r = 0.844, respectively, p < 0.01). However, there was no correlation between suprapatellar transverse US scan and MRI in medial condyle. In lateral condyle, both US scans showed good correlations with MRI. In Bland–Altman analysis, longitudinal US scan showed good agreement with MRI except in the minimal cartilage thickness of lateral condyle. There was high overall intra- and inter-observer agreement in US scan. US scan in the longitudinal plane is a more feasible method than suprapatellar transverse scan for measuring cartilage thickness of medial femoral condyle in knee OA patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Harris ED Jr (2001) The bone and joint decade: a catalyst for progress. Arthritis Rheum 44:1969–1970

    Article  PubMed  Google Scholar 

  2. March LM, Bachmeier CJ (1997) Economics of osteoarthritis: a global perspective. Bailliere’s Clin Rheumatol 11:817–834

    Article  CAS  Google Scholar 

  3. Eckstein F, Glaser C (2004) Measuring cartilage morphology with quantitative magnetic resonance imaging. Semin Musculoskelet Radiol 8:329–353

    Article  PubMed  Google Scholar 

  4. Cicuttini FM, Wluka AE, Wang Y et al (2004) Longitudinal study of changes in tibial and femoral cartilage in knee osteoarthritis. Arthritis Rheum 50:94–97

    Article  PubMed  CAS  Google Scholar 

  5. Peterfy CG (2002) Imaging of the disease process. Curr Opin Rheumatol 14:590–596

    Article  PubMed  Google Scholar 

  6. Graichen H, von Eisenhart-Rothe R, Vogl T et al (2004) Quantitative assessment of cartilage status in osteoarthritis by quantitative magnetic resonance imaging: technical validation for use in analysis of cartilage volume and further morphologic parameters. Arthritis Rheum 50:811–816

    Article  PubMed  Google Scholar 

  7. Dieppe PA, Cushnaghan J, Shepstone L (1997) The Bristol ‘OA500’ study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint. Osteoarthr Cartil 5:87–97

    Article  PubMed  CAS  Google Scholar 

  8. Winalski CS, Gupta KB (2003) Magnetic resonance imaging of focal articular cartilage lesions. Top Magn Reson Imaging 14:131–144

    Article  PubMed  Google Scholar 

  9. Disler DG, McCauley TR, Wirth CR et al (1995) Detection of knee hyaline cartilage defects using fat-suppressed three-dimensional spoiled gradient-echo MR imaging: comparison with standard MR imaging and correlation with arthroscopy. Am J Roentgenol 165:377–382

    CAS  Google Scholar 

  10. Grassi W, Lamanna G, Farina A et al (1999) Sonographic imaging of normal and osteoarthritic cartilage. Semin Arthritis Rheum 28:398–403

    Article  PubMed  CAS  Google Scholar 

  11. Tarhan S, Unlu Z (2003) Magnetic resonance imaging and ultrasonographic evaluation of the patients with knee osteoarthritis: a comparative study. Clin Rheumatol 22:181–188

    Article  PubMed  CAS  Google Scholar 

  12. Filippucci E, Iagnocco A, Meenagh G et al (2006) Ultrasound imaging for the rheumatologist. Clin Exp Rheumatol 24:1–5

    PubMed  CAS  Google Scholar 

  13. Boutry N, Morel M, Flipo RM et al (2007) Early rheumatoid arthritis: a review of MRI and sonographic findings. Am J Roentgenol 189:1502–1509

    Article  Google Scholar 

  14. Khoury V, Cardinal E, Bureau NJ (2007) Musculoskeletal sonography: a dynamic tool for usual and unusual disorders. Am J Roentgenol 188:W63–W73

    Article  Google Scholar 

  15. Iagnocco A, Perella C, Naredo E et al (2008) Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography. Clin Rheumatol 27:491–496

    Article  PubMed  Google Scholar 

  16. Wakefield RJ, Gibbon WW, Conaghan PG et al (2000) The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 43:2762–2770

    Article  PubMed  CAS  Google Scholar 

  17. Schmidt WA, Schmidt H, Schicke B et al (2004) Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis 63:988–994

    Article  PubMed  CAS  Google Scholar 

  18. Friedman L, Finlay K, Jurriaans E (2001) Ultrasound of the knee. Skeletal Radiol 30:361–377

    Article  PubMed  CAS  Google Scholar 

  19. Backhaus M, Burmester G-R, Gerber T et al (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–649

    Article  PubMed  CAS  Google Scholar 

  20. Altman R, Asch E, Bloch D 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 29:1039–1049

    Article  PubMed  CAS  Google Scholar 

  21. Bellamy N, Buchanan WW, Goldsmith CH et al (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    PubMed  CAS  Google Scholar 

  22. Bae SC, Lee HS, Yun HR et al (2001) Cross-cultural adaptation and validation of Korean Western Ontario and McMaster Universities (WOMAC) and Lequesne osteoarthritis indices for clinical research. Osteoarthritis Cartilage 9:746–750

    Article  PubMed  CAS  Google Scholar 

  23. Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 277(Suppl):7–72

    Google Scholar 

  24. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  PubMed  CAS  Google Scholar 

  25. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    PubMed  CAS  Google Scholar 

  26. Dewitte K, Fierens C, Stockl D et al (2002) Application of the Bland–Altman plot for interpretation of method-comparison studies: a critical investigation of its practice. Clin Chem 48:799–801

    PubMed  CAS  Google Scholar 

  27. Kramer M, Feinstein A (1981) Clinical biostatistics LIV; the biostatistics of concordance. Clin Pharmacol Ther 29:111–123

    PubMed  CAS  Google Scholar 

  28. Eckstein F, Charles HC, Buck RJ et al (2005) Accuracy and precision of quantitative assessment of cartilage morphology by magnetic resonance imaging at 3.0T. Arthritis Rheum 52:3132–3136

    Article  PubMed  Google Scholar 

  29. Tsai CY, Lee CL, Chai CY et al (2007) The validity of in vitro ultrasonographic grading of osteoarthritic femoral condylar cartilage—a comparison with histologic grading. Osteoarthritis Cartilage 15:245–250

    Article  PubMed  Google Scholar 

Download references


This study was supported by SRC grant R11-2002-098-04002-0 from the Korea Science and Engineering Foundation (KOSEF) to the Rheumatism Research Center at the Catholic University of Korea, Seoul.

Conflict of interest statement

The authors declare no conflicts of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ho-Youn Kim.

Additional information

Chong-Hyeon Yoon and Hyun-Sook Kim contributed equally as co-first authors to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoon, CH., Kim, HS., Ju, J.H. et al. Validity of the sonographic longitudinal sagittal image for assessment of the cartilage thickness in the knee osteoarthritis. Clin Rheumatol 27, 1507–1516 (2008).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: