{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T18:27:01Z","timestamp":1794335221443,"version":"4.9.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["nyaspubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann NY Acad Sci"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Deep learning models for Kellgren\u2013Lawrence (KL) grading often report optimistic performance due to data leakage and fail to generalize across institutions because of domain shift. To address this reproducibility crisis, we introduce KL\u2010FuseNet, a multitask architecture fusing global (ConvNeXt\u2010Base) and local (ResNet\u201050) features to predict ordinal grades, label distributions, and binary severity (KL\u22652). Using strict patient\u2010wise stratified splits on an internal osteoarthritis initiative dataset (\n                    <jats:italic>n<\/jats:italic>\n                    = 8260) and an independent Chinese cohort (\n                    <jats:italic>n<\/jats:italic>\n                    = 2295), we compared zero\u2010shot transfer against selective fine\u2010tuning. KL\u2010FuseNet achieved robust internal agreement (quadratic Cohen's kappa [QWK]: 0.881; accuracy: 70.3%). While external zero\u2010shot deployment revealed a domain gap, with accuracy dropping to 66.1%, our selective fine\u2010tuning protocol significantly bridged this divide, boosting external accuracy to 80.0% and QWK to 0.950, with an AUC of 0.984 for clinically significant osteoarthritis (KL\u22652). These results demonstrate that while KL\u2010FuseNet achieves state\u2010of\u2010the\u2010art performance under rigorous evaluation, domain\u2010aware adaptation is essential for clinical utility. This study establishes a reproducible pathway for deploying automated grading models across heterogeneous medical centers.\n                  <\/jats:p>","DOI":"10.1111\/nyas.70254","type":"journal-article","created":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T14:24:49Z","timestamp":1773498289000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cross\u2010Institutional Five\u2010Class Kellgren\u2013Lawrence Grading of Knee Osteoarthritis via Multitask Deep Learning"],"prefix":"10.1111","volume":"1557","author":[{"given":"Tariq","family":"Alkhatatbeh","sequence":"first","affiliation":[{"name":"Department of Joint Surgery, Center for Orthopaedic Surgery The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province)  Guangzhou China"},{"name":"Orthopedic Hospital of Guangdong Province  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Alkhatatbeh","sequence":"additional","affiliation":[{"name":"Department of Orthopedics The First Affiliated Hospital of Shantou University Medical College  Shantou City China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Center for Orthopaedic Surgery The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province)  Guangzhou China"},{"name":"Orthopedic Hospital of Guangdong Province  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhilin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Center for Orthopaedic Surgery The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province)  Guangzhou China"},{"name":"Orthopedic Hospital of Guangdong Province  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Center for Orthopaedic Surgery The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province)  Guangzhou China"},{"name":"Orthopedic Hospital of Guangdong Province  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weidong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Center for Orthopaedic Surgery The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province)  Guangzhou China"},{"name":"Orthopedic Hospital of Guangdong Province  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongkai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Center for Orthopaedic Surgery The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province)  Guangzhou China"},{"name":"Orthopedic Hospital of Guangdong Province  Guangzhou China"},{"name":"Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067\u2010025\u201007347\u20106"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.16.4.494"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.151300"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447\u201020121217\u201014"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010018\u201020132\u20107"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","unstructured":"J.Antony K.McGuinness N. 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