Table 2 Knee pain associations by feature and quality score
Author | Feature (method) | Knee pain outcome | Adjustment for confounders | Association (magnitude) crude | Association (magnitude) adjusted | Association | Quality score (%) |
|---|---|---|---|---|---|---|---|
MRI bone marrow lesion - cohort studies | |||||||
Foong 2014 [21] | Change in BML size (L) and incident BMLs (L) in all three knee compartments | WOMAC Knee pain severity at 2-year and 10-year visits (L) | Age, sex, BMI, leg strength, and the presence of ROA | NR | Incident or change in total BML size β = 1.53 (95 % CI 0.37 to 2.70. | + | High (67) |
Medial tibial change in BML size β = 2.96 (95 % CI 0.59-5.34 | Incidence of BML or increase in size associated with increase in pain in the medial tibia | ||||||
Driban 2013 [72] | Knee baseline BML volume (C), BML volume change (L) (TFJ) | 48-month change in WOMAC pain (L) | Age, sex, BMI | NR | β = 0.21 | + | High (61) |
(standard error 0.07) | Longitudinal (L) changes in BML correlated with (L) changes in pain severity | ||||||
p = 0.004 | |||||||
Dore 2010 [124] | MRI BML size (L) regional or whole TFJ over 2.7 years | Change in WOMAC pain (L) over 2.7 years | Age, sex, BMI, leg strength, quality of life, and baseline pain, function | β (95 % CI) Total BML size change = 1.06 (0.10 to 2.03) | β (95 % CI) total BML size change = 1.13 (0.28 to 1.98) | + | High (56) |
Kornaat 2007 [173] | Semi-quantitative MRI BML change over 2 years (L) TFJ | Mean WOMAC pain over 2 years | Age, sex and BMI | NR | β (95 % CI) = 2 (−8 to 11) | NA | High (56) |
Moisio 2009 [125] | Baseline MRI semi-quantitative BML score (C) TFJ and PFJ | Incident frequent knee pain 2 years after baseline (L) | Age, sex, BMI, BML score, % denuded bone | NR | OR (95 % CI) medial tibia and femur 1.41 (0.86 to 2.33), lateral tibia and femur 1.70 (1.07 to 2.69) | + Lateral TFJ BML score associated with incident frequent knee pain | High (56) |
Sowers 2011 [28] | Semi-quantitative MRI BML, size in TFJ (C) | Increasing WOMAC pain (L) | Nil | Medial and lateral TFJ BMLs both p <0.005 | NR | + | Low (53) |
Zhang 2011 [126] | Semi-quantitative change in MRI BML size (L) TFJ over 30 months | Incidence of frequent knee pain, and categorical severity (L) over 30 months | Synovitis and effusions | OR (95 % CI) Severity of frequent knee pain OR 3.0 (1.5 to 6.0) | OR (95 % CI) Incident frequent knee pain p for trend = 0.006. Severity of frequent knee pain OR 2.2 (1.0 to 4.7) p = 0.047 | + Ipsilateral association | Low (50) |
Wildi 2010 [95] | 24-month change in regional TFJ BML score WORMS (L) | 24-month change in WOMAC pain (L) | Nil | R <0.15, p >0.067 for all compartments | NR | NA, all compartments had no correlation | Low (50) |
Tanamas 2010 [89] | Baseline semi-quantitative MRI BML size (C) | Annual change in WOMAC pain (L) | Nil | NR | NR | NA | Low (50) |
MRI bone marrow lesion - cross-sectional studies | |||||||
Zhai 2006 [135] | Semi-quantitative MRI BML (C) | WOMAC pain >1 (C) | Age, BMI, sex, knee strength, chondral defects | NR | OR 1.44, 95 % CI 1.04, 2.00 | + | High (79) |
Sharma 2014 [133] | Semi-quantitative BML score WORMS TFJ or PFJ (C) | Prevalent frequent knee symptoms (C) | Age, sex, body mass index (BMI), previous knee injury, and previous knee surgery | NR | BMLs in any compartment OR 1.96, 95 % CI 1.38 to 2.77 | + BML association with prevalent knee symptoms | High (71) |
Kornaat 2006 [130] | Semi-quantitative MRI BML (C) | Chronic pain presence (C) | Age, sex, and BMI | NR | OR 1.13, 95 % 0.41, 3.11, p = 0.76 | NA | High (71) |
Lo 2009 [131] | Semi-quantitative MRI BML (BLOKS) (C) | WOMAC pain (C) | Synovitis, effusion scores | p for trend = 0.0009 | p for trend = 0.006 | + | High (71) |
Stefanik 2014 abstract [134] | BML (WORMS) (C) (patellofemoral joint) | Prevalent knee pain (any pain in last 30 days) and pain VAS (C) | Adjusted for age, sex, BMI, depressive symptoms and TFJ BMLs | NR | Isolated BML of the lateral PFJ, OR (95 % CI) 1.4 (0.9 to 2.0); medial PFJ, OR (95 % CI) 1.1 (0.8 to 1.5). Isolated lateral PFJ BMLs OR 6.6 (1.7 to 11.5) | NC | High (71) |
Ratzlaff 2013 [132] | Total BML volume in the femur or tibia (C) | Weight-bearing knee pain WOMAC subscale (C) | Age, sex, BMI, race, and medial minimum joint space width | NR | Total BML volume femur p = 0.003, tibia p = 0.101 | + Femoral NA Tibial | High (71) |
Ip 2011 [99] | Semi-quantitative MRI BML (C) | WOMAC pain (C) | Age, sex, BMI, OA stage, joint effusion, and meniscal damage | NR | Total WOMAC pain | NC | High (68) |
R = 0.05, 95 % CI −0.04 to 0.14. Stair climbing pain R = 0.09 (0.00 to 0.18) | |||||||
Torres 2006 [103] | MRI BML (WORMS) TFJ and PFJ (C) | Pain VAS (C) | Age, BMI | Coefficient 5.00, 95 % CI 3.00 to 7.00 | Coefficient 3.72, 95 % CI 1.76 to 5.68 | + | High (68) |
Kim 2013 [129] | Summary score and severity of MRI BML (WORMS) (C) | WOMAC pain severity or presence of knee pain (C) | Age, sex, BMI, radiographic OA | NR | BML summary score medial TFJ OR 2.33, 95 % CI 1.02 to 5.33, p <0.001 | + Severity of BML is proportional to WOMAC in medial compartment after adjustment | High (64) |
Moisio 2009 [125] | Baseline MRI semi-quantitative BML score (C) TFJ and PFJ | Presence of baseline moderate to severe knee pain (C) | Percent denuded bone, age, sex, BMI | NR | Bone marrow lesion score, OR 0.95, 95 % CI 0.63 to 1.44. Not significant in all compartments | NA found on cross-sectional analysis | High (64) |
Ratzlaff 2014 [48] Abstract | Median BML volume (PFJ, TFJ) (C) | Stair-climbing knee pain WOMAC (C) | Nil | TFJ p = 0.01, patellofemoral p = 0.01, femur p = 0.02, tibia p = 0.03 | NR | + | High (64) |
Hayes 2005 [22] | Semi-quantitative MRI BML (C) | Chronic pain presence (C) | Nil | p = 0.001 | NR | + | High (61) |
Ai 2010 [127] | Semi-quantitative MRI BML (C) | Pain verbal rating scale (Likert) (C) | Nil | p = 0.33 | NR | NA | Low (57) |
Bilgici 2010 [128] | MRI BML (WORMS) (C) | WOMAC pain, pain VAS (C) | Nil | WOMAC r = 0.508, p <0.01 Pain VAS r = 0.488, p <0.01 | NR | + | Low (57) |
Sowers 2003 [29] | Semi-quantitative MRI BML (C) | Chronic pain presence (C) | Nil | OR 5.0, 95 % CI 2.4 to 10.5 | NR | + | Low (54) |
Link 2003 [101] | Semi-quantitative MRI BML (C) | WOMAC pain (C) | Nil | p >0.05 | NR | NA | Low (54) |
Felson 2001 [96] | Semi-quantitative MRI BMLs (C) | Chronic knee pain presence (C) | Radiographic severity, age, sex, and effusion score | p <0.001 | OR 3.31, 95 % CI 1.54 to 7.41 | + | Low (54) |
Fernandez-Madrid 1994 [97] | Crude presence of MRI BMLs (C) | Crude pain presence (C) | Nil | NR | NR | NA | Low (46) |
MRI bone marrow lesion - case−control studies | |||||||
Javaid 2010 [140] | Baseline semi-quantitative MRI BML size (WORMS) (C) TFJ and PFJ | Incident frequent knee pain after 15 months (L) | Age, sex, race, BMI | NR | Whole knee OR 2.8, 95 % CI 1.2 to 6.5 | + | High (76) |
Felson 2007 [181] | Semi-quantitative MRI BML size increase (WORMS) (L) TFJ and PFJ | Incident frequent pain at 15 months (L) | Age, sex, race, BMI, quadriceps strength, KL score, malalignment, baseline BML score | OR 4.1, 95 % CI 2.1 to 8.1 | OR 3.2, 95 % CI 1.5 to 6.8 | + | High (71) |
Javaid 2012 [139] | Baseline Semi-quantitative MRI BML, (WORMS) (C) TFJ and PFJ | Presence of frequent knee pain (C) after 2 years | Nil | OR 1.70, 95 % CI 1.08 to | NR | + | Low (59) |
Zhao 2010 [105] | Baseline crude presence of MRI BMLs at (C) TFJ | Change in WOMAC Pain (L) | Nil | p = 0.60 | NR | NA | Low (56) |
Stahl 2011 [41] | Semi-quantitative MRI BML size (WORMS) (L) TFJ | Changes in WOMAC score (L) | Nil | NR | Data not shown | NA | Low (47) |
MRI osteophyte – cohort studies | |||||||
Sowers 2011 [28] | Semi-quantitative MRI osteophyte, size in TFJ (C) | Increasing WOMAC pain (L) | Nil | Medial and lateral TFJ BMLs both p <0.001 | NR | + | Low (53) |
MRI osteophyte - cross-sectional studies | |||||||
Kornaat 2006 [130] | Semi-quantitative MRI osteophyte (C) | Chronic pain presence (C) | Age, sex, BMI | NR | Patellofemoral OR 2.25, 95 % CI 1.06 to 4.77 | + | High (71) |
Sengupta 2006 [136] | Semi-quantitative MRI osteophyte (WORMS) (C) | Pain severity WOMAC, chronic pain (C) | Age, sex, BMI | NR | OR 0.97, 95 % CI 0.86 to 1.10 | NA | High (71) |
Torres 2006 [103] | MRI osteophyte, (WORMS) TFJ and PFJ (C) | Pain VAS (C) | Nil | Coefficient 1.18, 95 % CI 0.63 to 1.72 | Coefficient 0.50, 95 % CI 0.07 to 0.94 | NC | High (68) |
Hayes 2005 [22] | Semi-quantitative MRI osteophyte (C) | Chronic pain presence (C) | Nil | p <0.001 | NR | + | High (61) |
Ai 2010 [127] | Semi-quantitative MRI osteophytes (C) | Pain verbal rating scale (Likert) (C) | Nil | p = 0.166 | NR | NA | Low (57) |
Hayashi 2012 [137] | Crude presence of MRI osteophytes (C) | Presence of pain on WOMAC pain subscale (C) | Nil | OR 4.2 to 6.4, p = 0.001-0.011 | NR | + | Low (57) |
Link 2003 [101] | Semi-quantitative MRI osteophytes (C) | WOMAC pain (C) | Nil | p >0.05 | NR | NA | Low (54) |
Fernandez-Madrid 1994 [97] | Crude presence of MRI osteophytes (C) | Crude pain presence (C) | Nil | NR | NR | NA | Low (46) |
MRI osteophyte - case–control studies | |||||||
Javaid 2010 [140] | Baseline semi-quantitative MRI osteophyte, size (WORMS) (C) TFJ and PFJ | Incident frequent knee pain after 15 months (L) | Age, sex, race, BMI | NR | Whole knee severe osteophyte OR 4.7, 95 % CI 1.3 to 18 | + | High (76) |
MRI bone attrition - cross-sectional studies | |||||||
Hernandez-Molina 2008 [138] | Semi-quantitative MRI bone attrition (WORMS) (C) | Pain severity and nocturnal pain (WOMAC) (C) | Age, sex, BMI, BMLs, effusions and KL grade | OR (95 % CI) pain severity OR 1.6 (1.1 to 2.3), nocturnal pain OR 1.1 (0.5 to 2.1) | OR (95 % CI) pain severity OR 0.9 (0.6 to 1.4), nocturnal pain OR 1.0 (0.5 to 2.1). | NA | High (71) |
Torres 2006 [103] | MRI attrition, (WORMS) TFJ and PFJ (C) | Pain VAS (C) | Nil | Coefficient 3.33, 95 % CI 1.79 to 4.87 | Coefficient 1.91, 95 % CI 0.68 to 3.13 | + | High (68) |
MRI bone attrition - case−control studies | |||||||
Javaid 2012 [139] | Baseline semi-quantitative MRI attrition size (WORMS) (C) TFJ and PFJ | Presence of frequent knee pain (C) after 2 years | Nil | OR 2.40, 95 % CI 1.51 to 3.83 | NR | + | Low (59) |
MRI bone shape/dimension - cohort studies | |||||||
Everhart 2014 [114] | Baseline TFJ subchondral surface ratio of medial and lateral TFJ compartments (C) | Incident frequent knee pain at 48 months, (L) | Sex, race, age, BMI, tobacco use, activity level, knee coronal alignment, baseline symptoms, injury history, surgery history, KL grade, and JSW | NR | Medial SSR OR 0.48, 95 % CI 0.30 to 0.75, p = 0.0009. Lateral SSR OR 1.27, 95 % CI 0.86 to 1.88, p = 0.19 | - larger MSSR gets less incident frequent knee pain | High (61) |
MRI bone shape/dimension - cross-sectional studies | |||||||
Ochiai 2010 [47] | MRI irregularity of femoral condyle contour (C) | Knee pain VAS (C) | Nil | Irregularity of femoral condyle contour r = 0.472, p = 0.0021 | NR | + | Low (50) |
MRI bone cyst - cohort studies | |||||||
Sowers 2011 [28] | Semi-quantitative MRI bone cyst size in TFJ (C) | Increasing WOMAC pain (L) | Nil | NR | NR analysis described as not significant but data not shown | NA | Low (53) |
MRI bone cyst - cross-sectional studies | |||||||
Kornaat 2006 [130] | Semi-quantitative MRI bone cyst(C) | Chronic pain presence (C) | Nil | NR | Patellofemoral OR 1.83, 95 % CI (0.80 to 4.16) | NA | High (71) |
Torres 2006 [103] | MRI bone cyst (WORMS) TFJ and PFJ (C) | Pain VAS (C) | Age, BMI | Coefficient 2.50, 95 % CI −0.38 to 5.38 | Coefficient 0.82, 95 % CI −0.50 to 2.14 | NA | High (68) |
Hayes 2005 [22] | Semi-quantitative MRI bone cyst (C) | Chronic pain presence (C) | Age, sex, and BMI | p <0.001 | NR | + | High (61) |
Hayashi 2012 [137] | Crude presence of MRI bone cysts (C) | Presence of pain on WOMAC pain subscale (C) | Nil | OR 6.7 to 17.8, p = 0.004 to 0.03 | NR | + | Low (57) |
Link 2003 [101] | Crude presence of MRI bone cyst (C) | WOMAC pain (C) | Nil | p >0.05 | NR | NA | Low (54) |
MRI bone cyst - case control studies | |||||||
Javaid 2010 [140] | Baseline semi-quantitative MRI bone cyst size (WORMS) (C) TFJ and PFJ | Incident frequent knee pain after 15 months (L) | Nil | NR | NR p >0.1 | NA | High (76) |
Javaid 2012 [139] | Baseline semi-quantitative MRI bone cyst size (WORMS) (C) TFJ and PFJ | Presence of frequent knee pain (C) after 2 years | Nil | OR 1.61, 95 % CI 1.03 to 2.52 | NR | + | Low (59) |
qCT bone mineral density - cross-sectional studies | |||||||
Burnett 2012 [57] | BMD of patellar lateral facet (qCT) (C) | WOMAC – knee pain at rest (C) | Nil | Total lateral patella facet p = 0.04, inferior lateral facet p = 0.005 | NR |  | Low (57) |
2D Knee bone shape - cross-sectional studies | |||||||
Haverkamp 2011 [36] | 2D Bone shape knee, 1. femur and tibial width, 2. elevation of lateral tibial plateau (C) | Pain severity VAS (C) | Models adjusted for Age, BMI | NR | Bone width p = 0.167, lateral tibia plateau elevation p = 0.002 | + Lateral tibial plateau associated with pain severity, NA bone width with pain severity | Low (46) |