Wednesday, 29 May 2013

Osteoarthritis grading system - Kellgren and Lawrence

X-ray of knee with grade 1 osteoarthritisX-ray of  knee with grade 2 osteoarthritis
X-ray of knee with grade 3 osteoarthritisX-ray of knee with grade 4 osteoarthritis

Top Left - Grade I
Top Right - Grade II
Bottom Left - Grade III
Bottom Right - Grade IV

Photos source:

The Kellgren and Lawrence system for grading osteoarthritis is based on xrays and consists of Normal, Grade I, Grade II, Grade II and Grade IV.

It measures the presence of typical features of osteoarthritis:

Joint space narrowing - bone is visible on xray but the articular cartilage that covers it is not. A normal joint therefore appears to have a space between the bones. Any decrease in space implies a reduction in cartilage cover.

Osteophytes - small bony projections that form around joint margins. Thought to be a result of the body trying to increase joint surface area to decrease pressure. They are responsible for limiting range of motion and can cause pain.

Sclerosis - this means 'hardening' and is a sign of osteoarthritis, seen as increased white areas in the bone at the joint margins.

• Grade I: doubtful narrowing of joint space and possible osteophytic lipping
• Grade II: definite osteophytes, definite narrowing of joint space
• Grade III: moderate multiple osteophytes, definite narrowing of joint space, some sclerosis and possible deformity of bone contour
• Grade IV: large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone contour

You can read more here. A very nice blog dedicated to knee osteoarthritis.

A very nice pdf file with some general guidelines for assessment and treatment publishes by the Brigham and Women's Hospital can be found here.

(these sources were suggested to me by my classmate Bita Lotfaliei)