Table 1

Studies exploring the predictive value of MRI parameters and knee replacement

StudyDesign/patient characteristicsMRI parameterMain results
Cicuttini et al73Observational study
123 patients with osteoarthritis
113 completers at 2 years
18 (16%) knee replacements over 4 years		Quantitative MRI
Tibial cartilage volume loss over 2 years

  • ▸ 1% increase in tibial cartilage volume loss was associated with a 20% increase in risk for surgery (95% CI 10% to 30%)

  • ▸ Patients with tibial cartilage volume loss >8% had higher risk for surgery than those with >3% (OR, 7.1, 95% CI 1.4 to 36.5)

Wluka et al74Observational study
117 patients with knee osteoarthritis
18 (15%) knee replacements over 4 years		Semiquantitative MRI
Cartilage defect score

  • ▸ Higher cartilage defect scores (8 to 15) were associated with a higher risk for surgery than lower scores (2 to 7) (OR, 6.0, 95% CI 1.6 to 22.3)

Scher et al75Observational study
25 patients with knee osteoarthritis
48 patients with knee osteoarthritis and BML
15 (21%) knee replacements over 3 years		Semiquantitative MRI
BML

  • ▸ BML placed patients at higher risk for surgery (OR, 8.95, 95% CI 1.49 to 53.68)

  • ▸ Global BML placed patients at even higher risk (OR, 13.04, 95% CI 2.06 to 82.58)

  • ▸ No correlation for cartilage loss or meniscal change

Tanamas et al77 78Observational study
109 patients with knee osteoarthritis
16 (15%) knee replacements over 4 years		Quantitative MRI
BML and bone cysts

  • ▸ BML increased risk for surgery (OR, 1.57, 95% CI 1.04 to 2.35)

  • ▸ Both BML and bone cysts in the medial compartment further increased risk for surgery (OR, 1.99, 95% CI 1.01 to 3.90)

Dore et al80Community study
395 subjects
12 (3%) knee replacements over 5 years		Quantitative MRI
BML (right knee)

  • ▸ BML in right knee predicted surgery in both knees (right knee OR, 22.63, 95% CI 3.72 to ∞; left knee, OR, 12.85, 95% CI 1.82 to 90.91)

  • ▸ BML in right knee predicted surgery in both knees (right knee OR, 2.88, 95% CI 1.84 to 4.52; left knee, OR, 2.78, 95% CI 1.58 to 4.90)

Raynauld et al79Randomised controlled trial population
161 patients with knee osteoarthritis
18 (15%) knee replacements between 4 and 7 years		Semiquantitative MRI
BML, meniscal tears, and meniscal lesions
Quantitative MRI
Change in cartilage volume over 2 years

  • ▸ The strongest predictors of surgery were medial BML (OR, 1.48, 95% CI 1.21 to 1.82), severe medial meniscal tears (OR, 5.69, 95% CI 1.75 to 18.49), and medial meniscal extrusion (OR, 4.06, 95% CI 1.35 to 12.23)

  • ▸ Medial cartilage volume loss was also a strong predictor (OR, 18.70, 95% CI 2.40 to 145.67)

Eckstein et al76Case–control study (Osteoarthritis Initiative)
4796 patients with/at risk of knee osteoarthritis
165 (3.5%) knee replacements over 4 years
Controls without surgery		Quantitative MRI
Change in cartilage thickness and area of denuded bone from baseline to just before surgery

  • ▸ Patients with greater loss of cartilage thickness in central and total medial compartments had greater risk for surgery than controls (AUC, 0.59, 95% CI 0.52 to 0.67, p=0.006; and AUC 0.58, 95% CI 0.50 to 0.65, p=0.016, respectively)

  • ▸ Cartilage thickness loss appeared to be the strongest longitudinal predictor, while area of denuded bone was the best cross-sectional predictor

Roemer et al81Case–control study (Osteoarthritis Initiative)
4796 patients with/at risk of knee osteoarthritis
121 knee replacements over 4 years
121 matched controls without surgery		Semiquantitative MRI
BML

  • ▸ Worsening of BML size in ≥3 subregions in the medial tibiofemoral compartment was associated with increased odds of knee replacement compared to knees without worsening in any subregion in the same compartment (OR 3.35, 95% CI 1.14 to 9.82)

Roemer et al82Case–control study (Osteoarthritis Initiative)
4796 patients with/at risk of knee osteoarthritis
121 knee replacements over 4 years
121 matched controls without surgery		Semiquantitative MRI
Meniscal damage

  • ▸ Maceration of medial meniscal body (OR 2.78, 95% CI 1.50 to 5.16), maceration of the posterior horn (OR 2.20, 95% CI 1.07 to 4.53), and maximum grade meniscal maceration in any location (OR 2.96, 95% CI 1.51 to 5.82) were associated with higher odds of knee replacement than knees without these lesions

Guermazi et al83Case–control study (Osteoarthritis Initiative)
4796 patients with/at risk of knee osteoarthritis
121 knee replacements over 4 years
121 matched controls without surgery		Semiquantitative MRI
Hoffa synovitis and effusion synovitis

  • ▸ Knees that underwent knee replacement were more likely to have effusion-synovitis of any grade (OR 2.45, 95% CI 1.22 to 4.95) than controls

  • ▸ Knees that underwent knee replacement were more likely to have worsening Hoffa- (OR 7.00, 95% CI 1.59 to  30.80) and effusion synovitis (OR 2.27, 95% CI 1.11 to 4.62) than controls

  • BML, bone marrow lesions.