Assessing the Clinical Utility of MRI in Knee Osteoarthritis: Bridging the Gap Between Radiographic Findings and...

Conventionally, radiographs have been used to assess the severity of knee osteoarthritis (OA), but they fail to measure soft tissue changes responsible for generating symptoms. In recent literature, there is discordance between clinical symptoms and X-ray findings in knee OA. Therefore, we used MRI in our study to assess the correlation between patient-reported outcome measures as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and MRI findings as assessed by the Whole-Organ Magnetic Resonance Imaging Score (WORMS) score in knee OA. The study was done after approval from The Institutional Human Ethics Committee.

The sample size was calculated as 34. Eight women and 26 men who fulfilled the inclusion and exclusion criteria were included in the study. The knee with a higher Kellgren and Lawrence (KL) grade underwent MRI. The WOMAC score was used to assess pain, morning stiffness and physical function and the MRI findings were evaluated using the WORMS score. Spearman's rank correlation coefficient was used for correlation analysis.

The mean age was 53.5 ± 8.08 years, BMI 29.35 ± 4.51 kg/m², disease duration 2.57 ± 1.91 years, VAS score 5.08 ± 1.50, total WOMAC score 41.50 ± 10.80, and total WORMS score 64.78 ± 26.49. Statistical analysis revealed a positive correlation between WOMAC score and WORMS score (Spearman's rho value-0.645, p-value- < 0.05, Confidence Interval- 95%), and between WORMS score and KL grade (Spearman's rho value-0.637, p-value- < 0.05, Confidence Interval- 95%). There was no correlation between the WOMAC score and KL grade, highlighting the limitation of radiographs in reflecting symptom severity.

Conventional radiography is a good screening tool for knee osteoarthritis but cannot detect structural changes causing symptoms, leading to symptom-radiograph discordance. MRI better identifies these changes, as our study shows, and is useful when symptoms and radiographs misalign or conservative treatment fails. Future research should identify WORMS subgroups that better correlate with symptoms for improved diagnosis and management.