{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T09:59:21Z","timestamp":1790330361050,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82373653"],"award-info":[{"award-number":["82373653"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82472478"],"award-info":[{"award-number":["82472478"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2023A1515011518"],"award-info":[{"award-number":["2023A1515011518"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Evidence Based Medicine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate associations of symptomatic, radiographic, and structural knee indicators with radiographic osteoarthritis (OA) progression in the contralateral knee among individuals with or at risk of OA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the Osteoarthritis Initiative Database (accessed on December 21, 2022), with knees as the unit of analysis. Baseline exposures included symptomatic measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Knee injury and Osteoarthritis Outcome Score), radiographic features (radiographic OA status, Kellgren\u2013Lawrence [KL] grades, joint space width [JSW], and alignment), and magnetic resonance imaging (MRI)\u2010based structural abnormalities (MRI Osteoarthritis Knee Score [MOAKS]\u2010assessed lesions including cartilage defects, bone marrow lesions, meniscal morphology, Hoffa\u2010synovitis, and effusion\u2010synovitis). Outcomes were 4\u2010year contralateral KL grades and 4\u2010year JSW change. Generalized estimating equation models were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Each 1\u2010point increase in WOMAC total score was associated with increased contralateral KL grades (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 0.002, 95% confidence interval [CI], 0.001 to 0.003) and greater medial JSW narrowing (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = \u22120.005\u00a0mm, 95% CI, \u22120.007 to \u22120.003\u00a0mm). Radiographic OA status was associated with higher KL grades (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 0.112, 95% CI, 0.088 to 0.136) and reduced medial JSW (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = \u22120.179\u00a0mm, 95% CI, \u22120.236 to \u22120.122\u00a0mm) and lateral JSW (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = \u22120.168\u00a0mm, 95% CI, \u22120.257 to \u22120.079\u00a0mm). MRI\u2010based analyses showed that MOAKS\u2010defined structural damage was associated with greater contralateral JSW loss, with compartment\u2010specific patterns. Each 1\u2010point increase in medial tibiofemoral (TF) joint bone marrow lesion (BML) size was associated with a 0.045\u00a0mm decrease in contralateral medial JSW (95% CI, \u22120.065 to \u22120.025\u00a0mm), while each 1\u2010point increase lateral TF joint BML size was associated with a 0.048 mm decrease in contralateral lateral JSW (95% CI, \u22120.084 to \u22120.012\u00a0mm).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Worse symptomatic, radiographic, and structural knee status is associated with contralateral radiographic OA progression, suggesting contralateral knee condition should be considered in OA evaluation.<\/jats:p>\n                  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