Posttraumatic osteoarthritis after athletic knee injury: A narrative review of diagnostic imaging strategies.
Alexandra E Fogarty, Michael C Chiang, Stephanie Douglas and 6 others
PMID 39082212WHAT IT FOUND
No imaging test reliably detects early posttraumatic knee arthritis in athletes.
Radiographs miss early changes and grading is inconsistent. MRI is better but lacks standardization. Ultrasound is user-dependent and underestimates cartilage loss compared to MRI.
Key findings
01Radiographs are considered the gold standard for diagnosing knee arthritis but have low sensitivity for early changes and lack soft tissue visualization.
02There is no consensus on which MRI grading system is superior for athletes, and no study directly compared them against an arthroscopic standard.
03Ultrasound underestimates cartilage thickness changes by 21% to 25% compared to MRI and has limited visualization of deep structures.
STILL TO COME
How it was doneWhat they found
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What it does not show
This is a narrative review, not a systematic review with meta-analysis, so it does not provide pooled effect sizes or rigorous quality assessment of included studies. The review includes only 23 studies, with a small number for ultrasound (2) and radiographs (8), limiting generalizability. No included study directly compared MRI grading systems against an arthroscopic standard, leaving uncertainty about which is most accurate. Ultrasound normative values for athletes are poorly defined, and athletes have thicker cartilage than sedentary individuals, complicating interpretation.
Declared interests
One author, Adam Tenforde, serves as senior editor for PM&R Journal and receives honoraria from conference organizers. He has participated in research funded by various organizations including the Arnold P. Gold Foundation, Football Player Health Study, American Medical Society for Sports Medicine, Uniform Health Service, Enovis, and MTEC/Department of Defense. He is a paid consultant for State Farm Insurance.
The easy way to misread this
Do not assume any single imaging modality or grading system is the definitive standard for diagnosing early PTOA in athletes. The review highlights that radiographs miss early changes, MRI lacks standardized grading consensus, and ultrasound is user-dependent and less accurate than MRI for cartilage thickness.