Correlation between common clinical scores and imaging indicators in knee osteoarthritis

doi:10.3877/cma.j.issn.1674-134X.2026.03.007

Abstract

Abstract:

Objective

To investigate the differences in CT and MRI indicators between patients with knee osteoarthritis (KOA).

Methods

From April 2024 to September 2025, a total of 46 patients diagnosed with KOA and history of knee pain, aged from 40 to 80 years at the First Affiliated Hospital of Guangzhou Medical University were enrolled as the research subjects.The patients with knee infection, severe vital organs diseases, hemoragic tendency, etc. were excluded. According to the visual analogue scale (VAS) score, the patients were divided into two groups: the high-score group (VAS scoreequal or over three, n=23) and the low-score group (VAS scoreless than three, n=23). The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores, as well as CT and MRI imaging indicators, were compared between the two groups using independent samples t test or Mann-Whitney U test, as appropriate.

Results

The high-score group showed significantly higher scores in pain, stiffness, functional activity, and total WOMAC score than the low-score group (Z=-6.213, -4.550, -6.067, -6.066, all P<0.01). CT image findings: when the knee joint was flexed at 50 degrees, there was a significant difference in the patellar tilt angle (PTA) between the high-score group and the low-score group (Z=-2.169, P<0.05). MRI findings: the high-score group had higher scores than the low-score group in the following aspects: the percentage of cartilage defects in the corresponding area, the percentage of full-thickness cartilage defects in the corresponding area, osteophytes, meniscal signal abnormalities, and periarticular soft tissue signs (Z=-2.256, -2.070, -1.975, -3.238, -2.220, all P<0.05).

Conclusions

Patients in the high pain score group have significantly more severe knee joint dysfunction than those in the low pain score group. Meanwhile, imaging findings indicate that the level of pain score is associated with the narrowing of PTA when the knee joint is flexed at 50 degrees, as well as the severity of articular cartilage damage, osteophytes, meniscal degeneration, and periarticular soft tissue lesions.

Key words: Osteoarthritis，knee, Pain measurement, Tomography，X-ray computed, Magnetic resonance imaging

Yinglin Huang, Wanshi Pan, Qiqi Peng, Haojian Lin, Changsheng Liu, Guiyuan Li, Ying He, Yu Deng, Liming Lu, Juan Tong. Correlation between common clinical scores and imaging indicators in knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 307-313.

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https://zhgjwkzz.cma-cmc.com.cn/EN/Y2026/V20/I03/307

Figures/Tables 8

Figure 1 The angle pillow used for CT scanning. A shows knee flexion at 15°; B shows knee flexion at 50°

Figure 2 CT image measurements of the knee joint. A is FTA (femoral trochlear angle); B is CA (congruence angle); C is PTA (patellar tilt angle); D is LPTA (lateral patellar tilt angle); E is PFI (patellofemoral index); F is TT-TG (tibial tubercle-trochlear groove distance)

Figure 3 Bone region division of MOAKS (MRI osteoarthritis knee score). A shows the division of the patella into the medial region (M) and the lateral region (L), the patellar apex belongs to the medial subregion (arrow); B shows the division of the femur into the trochlear region (T), central region (C) and posterior region (P), the tibia is divided into anterior, central and posterior; C shows the division of the tibia into the medial region (M), subspinous region (S), and lateral region (L), and the femur is divided into the medial femoral condyle and the lateral femoral condyle, while the intercondylar notch belongs to the medial femur

Table 1 Comparison of general data between the two groups

组别 Groups	例数 Number of cases	性别（男/女） Gender（male/female）	年龄［岁，M（P₂₅，P₇₅）］ Age（year）	身体质量指数［kg/m²，（ $x ¯$ ±s）］
高积分组 High-score group	23	10/13	65（59，69）	24±3
低积分组 Low-score group	23	8/15	57（54，66）	23±3
统计值 Statistical values		χ²=-0.365	Z=-1.562	t=0.828
P值		＞0.05	＞0.05	＞0.05

Table 1 Comparison of general data between the two groups

组别 Groups	例数 Number of cases	性别（男/女） Gender（male/female）	年龄［岁，M（P₂₅，P₇₅）］ Age（year）	身体质量指数［kg/m²，（ $x ¯$ ±s）］
高积分组 High-score group	23	10/13	65（59，69）	24±3
低积分组 Low-score group	23	8/15	57（54，66）	23±3
统计值 Statistical values		χ²=-0.365	Z=-1.562	t=0.828
P值		＞0.05	＞0.05	＞0.05

Table 2 Comparison of WOMAC scores between the two groups

组别 Groups	例数 Number of cases	疼痛 Pain	僵硬 Stiffness	功能活动 Physical function	总分 Total score
高积分组 High-score group	23	14（10，20）	3（0，7）	41（31，59）	62（45，78）
低积分组 Low-score group	23	0（0，0）	0（0，0）	0（0，0）	0（0，0）
Z值		-6.213	-4.550	-6.067	-6.066
P值		＜0.01	＜0.01	＜0.01	＜0.01

Table 3 Comparison of CT image findings between the two groups at knee flexion 15°

组别 Groups	例数 Number of cases	FTA ［°，（ $x ¯$ ±s）］	CA ［°，M（P₂₅，P₇₅）］	PTA ［°，（ $x ¯$ ±s）］	LPTA ［°，M（P₂₅，P₇₅）］	PFI ［M（P₂₅，P₇₅）］	TT-TG ［mm，（ $x ¯$ ±s）］
高积分组 High-score group	23	134.4±5.8	9.0（3.0，14.0）	8.6±5.9	12.0（10.0，14.0）	1.1（0.9，1.6）	11.5±5.9
低积分组 Low-score group	23	131.7±6.4	5.0（0，14.0）	10.9±7.9	11.0（10.0，13.0）	1.1（1.0，1.3）	9.7±4.9
统计值 Statistical values		t=1.517	Z=-1.012	t=-1.120	Z=-0.899	Z=-0.085	t=1.094
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

Table 3 Comparison of CT image findings between the two groups at knee flexion 15°

组别 Groups	例数 Number of cases	FTA ［°，（ $x ¯$ ±s）］	CA ［°，M（P₂₅，P₇₅）］	PTA ［°，（ $x ¯$ ±s）］	LPTA ［°，M（P₂₅，P₇₅）］	PFI ［M（P₂₅，P₇₅）］	TT-TG ［mm，（ $x ¯$ ±s）］
高积分组 High-score group	23	134.4±5.8	9.0（3.0，14.0）	8.6±5.9	12.0（10.0，14.0）	1.1（0.9，1.6）	11.5±5.9
低积分组 Low-score group	23	131.7±6.4	5.0（0，14.0）	10.9±7.9	11.0（10.0，13.0）	1.1（1.0，1.3）	9.7±4.9
统计值 Statistical values		t=1.517	Z=-1.012	t=-1.120	Z=-0.899	Z=-0.085	t=1.094
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

Table 4 Comparison of CT image findings between the two groups at knee flexion 50°

组别 Groups	例数 Number of cases	FTA ［°，M（P₂₅，P₇₅）］	CA ［°，（ $x ¯$ ±s）］	PTA ［°，M（P₂₅，P₇₅）］	LPTA ［°，（ $x ¯$ ±s）］	PFI ［M（P₂₅，P₇₅）］	TT-TG ［mm，（ $x ¯$ ±s）］
高积分组 High-score group	23	132.0（129.0，134.0）	8.4±12.4	8.0（4.0，11.0）	17.0±5.3	1.1（0.8，1.4）	8.4±5.6
低积分组 Low-score group	23	130.0（127.0，136.0）	5.7±8.0	12.0（8.0，15.0）	16.8±5.6	1.1（0.8，1.2）	8.3±5.5
统计值 Statistical values		Z=-0.738	t=0.874	Z=-2.169	t=0.109	Z=-0.295	t=0.101
P值		＞0.05	＞0.05	＜0.05	＞0.05	＞0.05	＞0.05

Table 4 Comparison of CT image findings between the two groups at knee flexion 50°

组别 Groups	例数 Number of cases	FTA ［°，M（P₂₅，P₇₅）］	CA ［°，（ $x ¯$ ±s）］	PTA ［°，M（P₂₅，P₇₅）］	LPTA ［°，（ $x ¯$ ±s）］	PFI ［M（P₂₅，P₇₅）］	TT-TG ［mm，（ $x ¯$ ±s）］
高积分组 High-score group	23	132.0（129.0，134.0）	8.4±12.4	8.0（4.0，11.0）	17.0±5.3	1.1（0.8，1.4）	8.4±5.6
低积分组 Low-score group	23	130.0（127.0，136.0）	5.7±8.0	12.0（8.0，15.0）	16.8±5.6	1.1（0.8，1.2）	8.3±5.5
统计值 Statistical values		Z=-0.738	t=0.874	Z=-2.169	t=0.109	Z=-0.295	t=0.101
P值		＞0.05	＞0.05	＜0.05	＞0.05	＞0.05	＞0.05

Table 5 Comparison of MRI findings between the two groups

MRI影像学指标 MRI findings	高积分组 High-score group	低积分组 Low-score group	Z值	P值
例数 Number of cases	23	23
任意软骨缺损 Any cartilage defect	12.0（4.0，28.0）	4.0（1.0，13.0）	-2.256	0.024
全层软骨缺损 Whole layer cartilage defect	2.0（1.0，8.0）	0（0，5.0）	-2.070	0.038
全部骨髓损伤 Whole bone marrow injury	5.0（1.0，11.0）	2.0（0，8.0）	-1.439	0.150
骨髓水肿 Bone marrow edema	6.0（1.0，12.0）	3.0（0，8.0）	-1.467	0.142
骨赘 Osteophyte	8.0（2.0，28.0）	3.0（2.0，10.0）	-1.975	0.048
滑膜炎/关节积液 Synovitis/Joint effusion	2.0（1.0，3.0）	1.0（1.0，2.0）	-1.820	0.069
半月板至胫骨距离 Distance of meniscus to tibia	1.0（0，3.0）	0（0，1.0）	-1.855	0.064
半月板信号 Signal of meniscus	3.0（2.0，5.0）	1.0（1.0，2.0）	-3.238	0.001
韧带/肌腱 Ligament/tendon	0（0，0）	0（0，0）	0.000	1.000
周围征象 Peripheral signs	1.0（0，2.0）	0（0，1.0）	-2.220	0.026

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