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Extended report
Association of bone scintigraphic abnormalities with knee malalignment and pain
  1. V B Kraus1,
  2. G McDaniel1,
  3. T W Worrell2,
  4. S Feng4,
  5. T P Vail3,
  6. G Varju6,
  7. R E Coleman5
  1. 1
    Duke University Medical Center, Departments of Medicine, Durham, North Carolina, USA
  2. 2
    Duke University Medical Center, Departments of Physical Therapy, Durham, North Carolina, USA
  3. 3
    Duke University Medical Center, Departments of Surgery, Durham, North Carolina, USA
  4. 4
    Duke University Medical Center, Departments of Bioinformatics, Durham, North Carolina, USA
  5. 5
    Duke University Medical Center, Departments of Radiology, Durham, North Carolina, USA
  6. 6
    Department of Medicine, East Carolina University, Greenville, North Carolina, USA
  1. Correspondence to Dr V B Kraus, Box 3416, Duke University Medical Center, Durham, NC 27710, USA; vbk{at}


Objective: The information content of knee bone scintigraphy was evaluated, including pattern, localisation and intensity of retention relative to radiographic features of knee osteoarthritis, knee alignment and knee symptoms.

Methods: A total of 308 knees (159 subjects) with symptomatic and radiographic knee osteoarthritis of at least one knee was assessed by late-phase 99mTechnetium methylene disphosphonate bone scintigraph, fixed-flexion knee radiograph, full limb radiograph for knee alignment and for self-reported knee symptom severity. Generalised linear models were used to control for within-subject correlation of knee data.

Results: The compartmental localisation (medial vs lateral) and intensity of knee bone scan retention were associated with the pattern (varus vs valgus) (p<0.001) and severity (p<0.001) of knee malalignment and localisation and severity of radiographic osteoarthritis (p<0.001). Bone scan agent retention in the tibiofemoral, but not patellofemoral, compartment was associated with severity of knee symptoms (p<0.001) and persisted after adjusting for radiographic osteoarthritis (p<0.001).

Conclusion: To the authors’ knowledge, this is the first study describing a relationship between knee malalignment, joint symptom severity and compartment-specific abnormalities by bone scintigraphy. This work demonstrates that bone scintigraphy is a sensitive and quantitative indicator of symptomatic knee osteoarthritis. Used selectively, bone scintigraphy is a dynamic imaging modality that holds great promise as a clinical trial screening tool and outcome measure.

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  • Funding This work was funded by NIH/NIAMS grant RO1 AR48769 and NIH/NIA Pepper OAIC P30 AG028716, and supported by the National Center for Research Resources NIH MO1-RR-30, supporting the Duke General Clinical Research Unit where this study was conducted.

  • Competing interests None.

  • Ethics approval This study was approved and in accordance with the policies of the Duke Institutional Review Board.

  • Patient consent Obtained.