New Study: Not all Knee Aging is Pathological

The MRI shows joint changes in the knee…are those due to normal aging or a developing pathology like osteoarthritis?

Researchers from Sweden and Estonia set out to answer those and other questions. Their study, “A naturally aging knee, or development of early knee osteoarthritis?” was published in the July 21, 2018 edition of Osteoarthritis and Cartilage.

Karin Magnusson, Ph.D., with Lund University in Sweden, told OTW, “We were interested in gaining new knowledge of what can be regarded as ‘normal aging’ of the knee joint and what structural changes (seen on MR [magnetic resonance] images) can be considered ‘pathological,’ i.e. part of the early disease process of osteoarthritis.”

“The development of structural changes of knees in middle-aged persons (such as cartilage defects, meniscal tears, and osteophytes) are common irrespective of the presence of knee pain or other risk factors for osteoarthritis. It remains to be proven if at all the distinction of normal ageing and osteoarthritis can be made with imaging in the early stages of the disease.”

“Clinicians should avoid ordering costly knee MRI examinations unless the examination is truly needed to rule out other knee conditions (than osteoarthritis), e.g. conditions that warrants specific treatment. An MRI examination is typically not needed to diagnose knee osteoarthritis, it should preferably be a clinical diagnosis (not based on imaging).”

If an MRI is ordered, the surgeon should be very cautious in the interpretation of ‘pathological’ findings on the images as they rarely explain knee symptoms.”

“Structural changes in the knee joint are extremely common, irrespective of the presence or absence of knee symptoms, or the presence/absence other risk factors for knee osteoarthritis. Just because knee symptoms and joint changes on MRI co-occur, does not necessarily imply that the changes themselves are truly causing the patient’s knee pain.”

“Further, in the early stages of osteoarthritis (before so-called end-stage disease when total knee replacement is considered), arthroscopic treatment is rarely indicated.”