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. 2025 Sep 19;104(38):e44689. doi: 10.1097/MD.0000000000044689

The value of magnetic resonance imaging osteoarthritis knee score in cartilage damage and prognosis of knee osteoarthritis

Jinbao Li a,*, Xiuwei Zheng a
PMCID: PMC12459521  PMID: 40988182

Abstract

The aim of this study was to investigate the value of magnetic resonance imaging (MRI) osteoarthritis knee score in the assessment of cartilage damage and its prognosis in knee osteoarthritis (KOA). Fifty-two patients with cartilage damage in KOA were selected as the case group, while 50 subjects undergoing health checkups during the same period were selected as the control group. All subjects underwent MRI scans, and patients in the case group received arthroscopy. The severity and prognosis of KOA were assessed by comparing the T2 values of different cartilage regions between the 2 groups using the MRI osteoarthritis knee score. In addition, the preoperative and postoperative visual analogue scale scores of the case group were compared, and the correlation between the T2 values and the MIR osteoarthritis knee score was analyzed. Preoperative T2 values in all cartilage regions of the case group were significantly higher than those of the control group (P < .05), with no statistical difference postoperatively compared to the control group (P > .05). The preoperative MRI osteoarthritis knee score of the case group was notably higher than that of the control group, and although the postoperative score decreased, it remained higher than the control group (P < .05). Visual analogue scale scores significantly improved at all postoperative follow-up points (P < .05). T2 values were positively correlated with MRI scores (P < .05). MRI osteoarthritis knee score is positively correlated with the T2 value, which may effectively reflect the cartilage damage and prognosis in KOA, with significant clinical application value.

Keywords: cartilage damage, magnetic resonance imaging, osteoarthritis knee score, prognosis

1. Introduction

Knee osteoarthritis (KOA) is a common degenerative joint disease, primarily characterized by the degeneration of knee cartilage and bone hyperplasia. As the disease progresses, patients experience symptoms such as knee pain, swelling, and restricted mobility. Cartilage damage is one of the core pathological features of KOA, and its prognosis is influenced by various factors.[1] In recent years, as understanding of the pathological mechanisms of KOA has deepened, researchers have increasingly focused on methods for assessing early cartilage damage and disease progression.

Magnetic resonance imaging (MRI) is a crucial imaging technique used to assess cartilage damage in KOA.MRI can be categorized into 2 major types: morphological imaging and molecular imaging. Morphological imaging is mainly used to assess structural changes in the cartilage, such as cartilage thickness and osteophytes, while molecular imaging focuses on changes in the tissue composition of cartilage, including chondrocytes and extracellular matrix. Molecular imaging can detect changes in sodium ion concentration, proteoglycans, and glycosaminoglycans, thus revealing cartilage damage at the molecular level.[2,3]

Histologically, cartilage damage can result from trauma, mechanical load, and other non-physicochemical factors. Cartilage damage may involve various layers, including the superficial, transitional, radial, and calcified layers. Due to the lack of neural, vascular, and lymphatic supply in knee cartilage, its self-repair capacity is severely limited.[4] Moreover, cartilage damage in KOA is not merely a localized alteration; it also induces static changes in adjacent tissues, such as ligament injury and subchondral bone alterations, ultimately exacerbating the patient’s functional impairment.[5]

T2-weighted imaging plays a crucial role in assessing changes in the extracellular matrix of cartilage. T2 images reflect changes in extracellular glycosaminoglycans, water content, and proteoglycans, which are vital to cartilage health.[6,7] Different tissue components exhibit varying signal intensities on T2 images, typically represented through pseudocolor mapping.[8,9] These pseudocolor images can assist in detecting changes in cartilage composition, such as the loss of proteoglycans, reduction in water content, and movement of sodium ions, even before significant morphological changes occur.[10–15]

Recent studies have shown that T2 values can vary substantially among different cartilage regions due to variations in biomechanical loading, collagen fiber orientation, and local tissue composition. In particular, the lateral femur often demonstrates distinct T2 characteristics compared with the medial femur, likely because KOA-related degeneration more commonly affects the medial compartment, resulting in asymmetric loading patterns. However, the prognostic value of lateral femur T2 changes in KOA remains insufficiently studied, and its relationship with composite MRI scoring systems such as the Whole-Organ Magnetic Resonance Imaging Score (WORMS) has not been clearly established. In the present study, we focused on 5 cartilage regions: the medial femur, lateral femur, medial tibia, lateral tibia, and patellar cartilage. These regions were selected because they represent the major load-bearing and articulating surfaces of the knee joint, where biomechanical stresses and degenerative changes differ substantially. The medial compartment, including the medial femur and medial tibia, is typically subjected to greater mechanical loading and is more frequently involved in KOA pathology. The lateral femur and lateral tibia were included to examine potential inter-compartmental variability and address the limited evidence regarding lateral compartment degeneration. The patellar cartilage was assessed due to its role in patellofemoral osteoarthritis, which can contribute significantly to anterior knee pain. This region-specific approach allows for a more comprehensive evaluation of compartmental pathology and prognostic differences in KOA.

Therefore, the aim of this study was to explore the application value of MRI KOA score in assessing cartilage damage and prognosis of KOA. Through this research, it is hoped to provide new insights and methods for the early diagnosis and progression monitoring of KOA.

2. Methods

2.1. General data

A total of 52 patients with cartilage damage in KOA treated at our hospital from May 2022 to April 2024 were selected as the case group, while 50 subjects undergoing health checkups during the same period were selected as the control group. In the case group, there were 30 males and 22 females, aged between 38 and 69 years, with a mean age of (56.93 ± 3.64) years. In the control group, there were 29 males and 21 females, aged between 39 and 70 years, with a mean age of (57.01 ± 3.57) years. The baseline data of both groups were comparable (P > .05). This study was approved by the ethics committee of Tianjin Hospital. All patients provided written informed consent prior to enrollment in the study.

The sample size was determined based on the total number of patients who met the inclusion criteria during the study period. A retrospective power analysis (α = 0.05, power = 0.8) using the pre–post differences in T2 values as the primary outcome confirmed that the study had sufficient statistical power to detect clinically meaningful differences.

2.2. Inclusion and exclusion criteria

Inclusion criteria: patients who met the diagnostic standards for cartilage damage in KOA; patients with complete imaging data; patients who underwent arthroscopic treatment; patients who underwent MRI examination.

Exclusion criteria: patients who did not meet the diagnostic standards; patients with concomitant rheumatoid arthritis, gout, or other rheumatologic immune disorders; patients with tuberculosis, tumors, or other severe systemic diseases; lost to follow-up at any postoperative assessment point.

2.3. MRI examination and region selection

All subjects underwent MRI scans using a 3.0T MR system. With the patient in a supine position and the knee joint fully extended, the field of view, layer thickness, and other parameters were set for scanning sagittal 3D fast gradient echo sequence and coronal fat-suppressed fast spin-echo inversion recovery sequence. The T2 values of different regions of the knee cartilage were compared between the 2 groups. T2 mapping imaging data were input into the Syngo workstation, and post-processing software was used to generate T2 mapping pseudocolor images of the knee cartilage. The region of interest was selected, and T2 values of the cartilage were measured directly on the T2 map. Regions of interest were manually delineated in the medial femur, lateral femur, medial tibia, lateral tibia, and patellar cartilage, as these represent the primary load-bearing and articulating surfaces of the knee with distinct biomechanical and pathological relevance in KOA. Each layer was measured 3 times manually, and the average value was taken.

The case group received arthroscopic treatment. The patients were treated with arthroscopic surgery under epidural or general anesthesia. According to the MRI imaging manifestations of KOA, the severity of subchondral lesions was evaluated with reference to the WORMS, with a score of 0 to 5 indicating normal to very cartilage lesions, respectively.

2.4. Observation indicators

MRI osteoarthritis knee score was used to evaluate the severity and prognosis of the 2 groups of MRI examinations. The visual analogue scale (VAS) scores of the case group were calculated on the 1st day after surgery, 4 weeks after surgery, and 12 weeks after surgery, and the correlation between T2 values and MRI osteoarthritis knee score was analyzed.

2.4.1. Outcome measures

MRI osteoarthritis knee scores and T2 values of the defined cartilage regions were recorded preoperatively and postoperatively. Pain was assessed using the VAS at baseline, postoperative day 1, 4 weeks, and 12 weeks.

2.5. Statistical processing

All analyses were performed using SPSS 26.0 (IBM Corp., Chicago). Continuous variables were expressed as mean ± SD. Pre- and postoperative comparisons within the same patients were analyzed using paired t-tests; if the normality assumption (Shapiro–Wilk test) was violated, the Wilcoxon signed-rank test was applied. For variables assessed at multiple postoperative time points (e.g., VAS scores, T2 values), repeated measures ANOVA was used if assumptions of normality and sphericity (Mauchly test) were met; otherwise, the Greenhouse–Geisser correction was applied or the Friedman test was used for nonparametric data, followed by post hoc pairwise comparisons with Bonferroni correction. Pearson or Spearman correlation analysis was used to examine relationships between T2 values and MRI osteoarthritis knee scores, depending on data distribution. Categorical variables were compared using the χ² test. Patients lost to follow-up were excluded from the analysis, and no data imputation was performed. A two-tailed P value < .05 was considered statistically significant.

3. Results

3.1. Comparison of T2 values in different regions of knee cartilage between groups

The cartilage T2 values of the medial femur (46.76 ± 3.35) ms, lateral femur (45.47 ± 1.93) ms, medial tibia (38.53 ± 2.47) ms, lateral tibia (39.83 ± 3.68) ms, and patellar region (41.28 ± 2.75) ms in the case group were significantly higher than those in the control group before surgery (P < .05). After surgery, the cartilage T2 values of medial femur (42.08 ± 2.24) ms, lateral femur (20.06 ± 2.31) ms, medial tibia (33.29 ± 2.42) ms, lateral tibia (32.95 ± 2.47) ms, and patellar region (33.08 ± 2.16) ms in the case group were not statistically different from those in the control group (P > .05; Fig. 1, Table 1).

Figure 1.

Figure 1.

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Comparison of T2 values in different regions of knee cartilage between groups. (A) Lateral femur. (B) Medial femur. (C) Lateral tibia. (D) Medial tibia. (E) Patellar region. Note: Compared with before surgery, *P < .05.

Table 1.

Comparison of T2 values in different regions of knee cartilage between groups (Mean ± SD, ms).

Group Lateral femur Medial femur Lateral tibia Medial tibia Patellar region
Case group (n = 52)
 Before surgery 45.47 ± 1.93* 46.76 ± 3.35* 39.83 ± 3.68* 38.53 ± 2.47* 41.28 ± 2.75*
 After surgery 20.06 ± 2.31 42.08 ± 2.24 32.95 ± 2.47 33.29 ± 2.42 33.08 ± 2.16
Control group (n = 50) 17.62 ± 2.57 40.32 ± 1.96 31.87 ± 2.25 32.29 ± 1.86 32.89 ± 1.72
95% CI of difference 26.97–28.73 5.38–7.50 6.78–9.14 5.39–7.09 7.50–9.28
Cohen d 12.29 2.34 2.60 2.85 3.64
F 22.054 11.273 14.486 15.019 17.268
P .000 <.001 .000 .000 .000
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Compared with before surgery.

*

P < .05.

3.2. Comparison of MRI osteoarthritis knee scores between groups

The MRI osteoarthritis knee score of the case group before surgery (4.28 ± 0.26) was elevated compared with that of the control group (0) and after surgery (1.82 ± 0.09), and the MRI osteoarthritis knee score was elevated after surgery compared with that of the control group, exhibiting statistically significant difference (P < .05; Fig. 2).This residual postoperative elevation suggests the presence of persistent structural abnormalities detectable by MRI, which may represent irreversible cartilage changes despite marked clinical improvement. Such findings could have prognostic implications, indicating potential vulnerability to future degeneration even after successful symptom relief.

Figure 2.

Figure 2.

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Comparison of MRI osteoarthritis knee scores between groups. Note: compared with the control group, *P < .05, **P < .01; compared with before surgery, #P < .05. MRI = magnetic resonance imaging.

3.3. Comparison of preoperative and postoperative VAS scores in the case group

The differences in VAS scores of the case groups were statistically significant when compared the preoperative and postoperative follow-up time points (P < .05). Compared with before surgery, VAS scores decreased in both groups on the 1st day, 4 weeks, and 12 weeks after surgery, and the decrease was more significant at 12 weeks, showing statistically significant difference (P < .05; Fig. 3).

Figure 3.

Figure 3.

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Comparison of preoperative and postoperative VAS scores in the case group. Note: compared with before surgery, *P < .05, **P < .01; compared with 1 day after surgery, #P < .05. VAS = visual analogue scale.

3.4. Correlation between T2 values of different regions of knee cartilage and MRI osteoarthritis knee scores in the case group

There was no correlation between the T2 values of lateral femur and MRI osteoarthritis knee scores in the case group (P > .05), whereas there was a positive correlation between the T2 values of medial femur, lateral tibia, medial tibia, and patellar region and MRI osteoarthritis knee scores in the case group (P < .05; Table 2).The absence of a correlation in the lateral femur may be related to its distinct biomechanical environment. In typical KOA patterns, the medial compartment bears greater mechanical loading, while the lateral femur experiences lower loading forces and a different pattern of cartilage degeneration. These factors may reduce the sensitivity of lateral femur T2 values to changes captured by composite MRI scoring systems.

Table 2.

Correlation between T2 values of different regions of knee cartilage and MRI osteoarthritis knee scores in the case group.

T2 value MRI osteoarthritis knee scores
r P
Lateral femur 0.014 .478
Medial femur 0.452 .002
Lateral tibia 0.623 .000
Medial tibia 0.775 .000
Patellar region 0.509 .001
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MRI = magnetic resonance imaging.

3.5. Typical case

The imaging data and case analysis are shown in Figures 4 and 5.

Figure 4.

Figure 4.

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Case 1: Patient with preoperative medial cartilage damage to the distal femur and marrow damage to the proximal tibia.

Figure 5.

Figure 5.

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Case 2: Patient with preoperative anterior cruciate rupture and postoperative repair.

4. Discussion

KOA is a prevalent degenerative joint disease, characterized by cartilage degeneration and loss, bone hyperplasia, and joint space narrowing.[16–18,19] For patients with KOA, early detection combined with effective treatment can alleviate symptoms and slow disease progression, but reversing structural cartilage damage remains challenging due to its limited intrinsic repair capacity.[20,21] The primary pathological feature of KOA is the degradation and damage of articular cartilage. Due to its lack of nerve and vascular supply, the cartilage has a limited capacity for self-healing or repair after degenerative changes. Cartilage damage not only causes joint pain but also exacerbates the destruction of joint structures and results in functional impairment.[22]

Currently, most conventional treatments such as medication and physical therapy can only provide short-term relief from patients’ pain symptoms, without fundamentally reversing or restoring the normal structure and function of cartilage. The prognosis for cartilage damage in KOA is influenced by various factors, but with early diagnosis, effective treatment, and a healthy lifestyle, patients’ quality of life can be significantly improved.[23] The prognosis of KOA is affected by several factors, including the patient’s age, severity of the condition, choice of treatment, and compliance.[24] While conventional treatments may alleviate symptoms to some extent, they struggle to reverse disease progression. Novel therapeutic approaches offer new options for KOA patients and have demonstrated promising outcomes in clinical trials, both in treatment efficacy and prognosis improvement.[25]

MRI, as a sensitive and noninvasive diagnostic tool, plays a crucial role in diagnosing KOA and assessing cartilage damage. MRI provides a clear depiction of the anatomical structures of the knee, including the articular cartilage, meniscus, ligaments, synovium, and joint cavity, offering unique advantages in evaluating cartilage damages, joint effusion, and osteophyte formation.[22] MRI not only detects early cartilage lesions but also quantifies the severity of the lesions, providing critical support for clinical diagnosis and treatment.[22] On MRI images, cartilage damage in KOA manifests as changes in cartilage signal, reduced cartilage thickness, and alterations in the subchondral bone. The T2 mapping sequence, as a specialized MRI technique, can reflect changes in water molecules, collagen fibers, and tissue anisotropy within cartilage, making it particularly sensitive to cartilage damage.[26] The results of this study showed that preoperative T2 values in all examined regions were significantly higher in KOA patients than in controls, with postoperative values approaching control levels in most regions.

Compared with X-ray and CT, MRI is able to detect small lesions in cartilage earlier and accurately assess the degree of damage. In addition, MRI can also show changes in other structures within the joint, such as meniscus, ligaments, synovium, etc, providing comprehensive information for clinical diagnosis and treatment. The findings of this study demonstrate that MRI can noninvasively and clearly reveal morphological and structural changes in joint cartilage, with high sensitivity and specificity for cartilage damage. Compared to X-ray and CT, MRI can detect subtle cartilage lesions at an earlier stage and accurately assess the extent of damage. Additionally, MRI can display changes in other intra-articular structures, such as the meniscus, ligaments, and synovium, providing comprehensive information for clinical diagnosis and treatment.

Currently, various MRI grading systems are employed for the diagnosis and study of KOA, the more commonly used of which include the Boston Leeds Osteoarthritis Knee Score and the WORMS. These systems provide a quantitative assessment of lesions in different regions of the knee joint to comprehensively evaluate the severity of the disease. The WORMS scoring system is more comprehensive, which not only includes the elements of Boston Leeds Osteoarthritis Knee Score but also extends to the evaluation of structures such as ligaments and menisci.[27] Our results support the application of such systems, particularly when combined with quantitative T2 mapping, to provide both morphological and compositional assessment and to monitor prognosis.

At the same time, MRI osteoarthritis knee score can also provide researchers with standardized methods of data collection and analysis and promote in-depth research in related fields.[28] The application of MRI scoring system in cartilage damage in KOA has significant advantages, which can accurately and reliably assess the extent of cartilage damage and other changes in joint structure. With the continuous advancement of technology and in-depth promotion of its application, MRI osteoarthritis knee score is expected to become an important auxiliary approach for the diagnosis and treatment of KOA.[29,30]

Limitations of our study include the absence of an a priori sample size calculation (although retrospective power analysis confirmed adequate power), the need to adjust for multiple comparisons (Bonferroni correction applied in this revision), and the short postoperative follow-up (12 weeks), which limits long-term prognostic assessment. Future research with larger cohorts, longer follow-up, and full joint assessment using advanced 3D mapping could strengthen these findings.

In conclusion, this study demonstrates that combining T2 mapping with MRI osteoarthritis knee scoring yields complementary insights into cartilage damage and prognosis in KOA. The compartment-specific findings for the lateral femur and the clinical significance of residual postoperative abnormalities underscore the importance of region-focused imaging assessment and long-term monitoring.

Author contributions

Conceptualization: Jinbao Li, Xiuwei Zheng.

Data curation: Jinbao Li, Xiuwei Zheng.

Formal analysis: Jinbao Li, Xiuwei Zheng.

Investigation: Jinbao Li.

Methodology: Jinbao Li, Xiuwei Zheng.

Project administration: Xiuwei Zheng.

Validation: Jinbao Li.

Writing – original draft: Jinbao Li, Xiuwei Zheng.

Writing – review & editing: Jinbao Li, Xiuwei Zheng.

Abbreviations:

KOA
knee osteoarthritis
MRI
magnetic resonance imaging
VAS
visual analogue scale
WORMS
Whole-Organ Magnetic Resonance Imaging Score

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Li J, Zheng X. The value of magnetic resonance imaging osteoarthritis knee score in cartilage damage and prognosis of knee osteoarthritis. Medicine 2025;104:38(e44689).

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