{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:54:53Z","timestamp":1762080893919,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T00:00:00Z","timestamp":1671753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Osteoarthritis (OA) of the knee is a degenerative disorder characterized by damage to the joint cartilage, pain, swelling, and walking disability. The purpose of this study was to assess whether demographic and radiologic parameters (knee diameters and knee cross-sectional area from magnetic resonance (MR) images) could be used as surrogate biomarkers for the prediction of OA. Materials and Methods: The knee diameters and cross-sectional areas of 481 patients were measured on knee MR images, and the corresponding demographic parameters were extracted from the patients\u2019 clinical records. The images were graded based on the modified Outerbridge arthroscopic classification that was used as ground truth. Receiver-operating characteristic (ROC) analysis was performed on the collected data. Results: ROC analysis established that age was the most accurate predictor of severe knee cartilage degeneration (corresponding to Outerbridge grades 3 and 4) with an area under the curve (AUC) of the specificity\u2013sensitivity plot of 0.865 \u00b1 0.02. An age over 41 years was associated with a sensitivity and specificity for severe degeneration of 82.8% (CI: 77.5\u201387.3%), and 76.4% (CI: 70.4\u201381.6%), respectively. The second-best degeneration predictor was the normalized knee cross-sectional area, with an AUC of 0.767 \u00b1 0.04), followed by BMI (AUC = 0.739 \u00b1 0.02), and normalized knee maximal diameter (AUC = 0.724 \u00b1 0.05), meaning that knee degeneration increases with increasing knee diameter. Conclusions: Age is the best predictor of knee damage progression in OA and can be used as surrogate marker for knee degeneration. Knee diameters and cross-sectional area also correlate with the extent of cartilage lesions. Though less-accurate predictors of damage progression than age, they have predictive value and are therefore easily available surrogate markers of OA that can be used also by general practitioners and orthopedic surgeons.<\/jats:p>","DOI":"10.3390\/medicina59010027","type":"journal-article","created":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T02:36:46Z","timestamp":1671763006000},"page":"27","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Knee Diameter and Cross-Sectional Area as Biomarkers for Cartilage Knee Degeneration on Magnetic Resonance Images"],"prefix":"10.3390","volume":"59","author":[{"given":"Elias","family":"Primetis","sequence":"first","affiliation":[{"name":"Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dionysios","family":"Drakopoulos","sequence":"additional","affiliation":[{"name":"Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6532-2594","authenticated-orcid":false,"given":"Dominik","family":"Sieron","sequence":"additional","affiliation":[{"name":"Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo","family":"Meusburger","sequence":"additional","affiliation":[{"name":"Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0853-9014","authenticated-orcid":false,"given":"Karol","family":"Szyluk","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland"},{"name":"District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 St., 41-940 Piekary Slaskie, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pawe\u0142","family":"Niemiec","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verena C.","family":"Obmann","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9864-6381","authenticated-orcid":false,"given":"Alan A.","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian T.","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Ebner","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios","family":"Delimpasis","sequence":"additional","affiliation":[{"name":"Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2355-2591","authenticated-orcid":false,"given":"Andreas","family":"Christe","sequence":"additional","affiliation":[{"name":"Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"},{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1056\/NEJMcp1903768","article-title":"Osteoarthritis of the Knee","volume":"384","author":"Sharma","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1002\/art.1780290816","article-title":"Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association","volume":"29","author":"Altman","year":"1986","journal-title":"Arthritis Rheum."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1002\/art.23548","article-title":"Biomechanics of cartilage articulation: Effects of lubrication and degeneration on shear deformation","volume":"58","author":"Wong","year":"2008","journal-title":"Arthritis Rheum."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.csm.2017.02.001","article-title":"Basic Science of Articular Cartilage","volume":"36","author":"Carballo","year":"2017","journal-title":"Clin. Sports Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1007\/s10067-010-1547-7","article-title":"Prevalence of anxiety and depression in osteoarthritis: Use of the Hospital Anxiety and Depression Scale as a screening tool","volume":"29","author":"Axford","year":"2010","journal-title":"Clin. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e007568","DOI":"10.1136\/bmjopen-2014-007568","article-title":"Body mass index and risk of knee osteoarthritis: Systematic review and meta-analysis of prospective studies","volume":"5","author":"Zheng","year":"2015","journal-title":"BMJ Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1097\/gme.0b013e318198e30e","article-title":"Women have increased rates of cartilage loss and progression of cartilage defects at the knee than men: A gender study of adults without clinical knee osteoarthritis","volume":"16","author":"Hanna","year":"2009","journal-title":"Menopause"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sieron, D., Jablonska, I., Lukoszek, D., Szyluk, K., Meusburger, H., Delimpasis, G., Kostrzewa, M., Platzek, I., and Christe, A. (2022). Knee Diameter and Cross-Section Area Measurements in MRI as New Promising Methods of Chondromalacia Diagnosis-Pilot Study. Medicina, 58.","DOI":"10.3390\/medicina58091142"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"565","DOI":"10.2174\/1573405614666181018123251","article-title":"Visualization of Cartilage from Knee Joint Magnetic Resonance Images and Quantitative Assessment to Study the Effect of Age, Gender and Body Mass Index (BMI) in Progressive Osteoarthritis (OA)","volume":"15","author":"Matada","year":"2019","journal-title":"Curr. Med. Imaging Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1111\/1756-185X.14255","article-title":"Metabolic obesity and the risk of knee osteoarthritis progression in elderly community residents: A 3-year longitudinal cohort study","volume":"25","author":"Go","year":"2022","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s00335-016-9641-z","article-title":"Cellular ageing mechanisms in osteoarthritis","volume":"27","author":"Sacitharan","year":"2016","journal-title":"Mamm. Genome"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.joca.2009.08.010","article-title":"Risk factors for onset of osteoarthritis of the knee in older adults: A systematic review and meta-analysis","volume":"18","author":"Blagojevic","year":"2010","journal-title":"Osteoarthritis Cartilage"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1007\/s00296-019-04290-z","article-title":"Modifiable risk factors in knee osteoarthritis: Treatment implications","volume":"39","author":"Georgiev","year":"2019","journal-title":"Rheumatol. Int."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Martin, K.R., Kuh, D., Harris, T.B., Guralnik, J.M., Coggon, D., and Wills, A.K. (2013). Body mass index, occupational activity, and leisure-time physical activity: An exploration of risk factors and modifiers for knee osteoarthritis in the 1946 British birth cohort. BMC Musculoskelet. Disord., 14.","DOI":"10.1186\/1471-2474-14-219"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.joca.2005.08.002","article-title":"3.0 vs 1.5 T MRI in the detection of focal cartilage pathology--ROC analysis in an experimental model","volume":"14","author":"Link","year":"2006","journal-title":"Osteoarthritis Cartilage"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/jmri.20815","article-title":"3.0 Tesla imaging of the musculoskeletal system","volume":"25","author":"Kuo","year":"2007","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1060","DOI":"10.3928\/01477447-20130724-24","article-title":"3.0-Tesla MRI and arthroscopy for assessment of knee articular cartilage lesions","volume":"36","author":"Reed","year":"2013","journal-title":"Orthopedics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1055\/s-0037-1620233","article-title":"Magnetic Resonance Imaging of Articular Cartilage within the Knee","volume":"31","author":"Argentieri","year":"2018","journal-title":"J. Knee Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e12401","DOI":"10.1097\/MD.0000000000012401","article-title":"Comparison of 1.5- and 3.0-T magnetic resonance imaging for evaluating lesions of the knee: A systematic review and meta-analysis (PRISMA-compliant article)","volume":"97","author":"Cheng","year":"2018","journal-title":"Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1148\/radiol.2503080822","article-title":"Comparison of 1.5- and 3.0-T MR imaging for evaluating the articular cartilage of the knee joint","volume":"250","author":"Kijowski","year":"2009","journal-title":"Radiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1007\/s11999.0000000000000255","article-title":"Classifications in Brief: Outerbridge Classification of Chondral Lesions","volume":"476","author":"Slattery","year":"2018","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"aax9086","DOI":"10.1126\/scitranslmed.aax9086","article-title":"Agrin induces long-term osteochondral regeneration by supporting repair morphogenesis","volume":"12","author":"Eldridge","year":"2020","journal-title":"Sci. Transl. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1302\/0301-620X.102B10.BJJ-2020-0527.R1","article-title":"Retrospective evaluation of outcomes of bone peg fixation for osteochondral lesion of the talus","volume":"102","author":"Park","year":"2020","journal-title":"Bone Jt. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s00167-019-05531-1","article-title":"Patellar height measurements: Insall-Salvati ratio is most reliable method","volume":"28","author":"Verhulst","year":"2020","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/s00256-017-2714-6","article-title":"Routine clinical knee MR reports: Comparison of diagnostic performance at 1.5 T and 3.0 T for assessment of the articular cartilage","volume":"46","author":"Mandell","year":"2017","journal-title":"Skeletal. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1007\/s00256-009-0683-0","article-title":"Comparative study of imaging at 3.0 T versus 1.5 T of the knee","volume":"38","author":"Wong","year":"2009","journal-title":"Skeletal. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.5435\/00124635-200700001-00007","article-title":"Sex Differences in Osteoarthritis of the Hip and Knee","volume":"15","year":"2007","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Grotle, M., Hagen, K.B., Natvig, B., Dahl, F.A., and Kvien, T.K. (2008). Obesity and osteoarthritis in knee, hip and\/or hand: An epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet. Disord., 9.","DOI":"10.1186\/1471-2474-9-132"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1002\/art.24021","article-title":"Lifetime risk of symptomatic knee osteoarthritis","volume":"59","author":"Murphy","year":"2008","journal-title":"Arthritis Rheum."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1053\/apmr.2001.23995","article-title":"Characterization of the human quadriceps muscle in active elders","volume":"82","author":"Stevens","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_31","first-page":"44","article-title":"The Role of Aging in the Development of Osteoarthritis","volume":"128","author":"Loeser","year":"2017","journal-title":"Trans. Am. Clin. Climatol. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13075-016-0922-4","article-title":"Hyaluronan concentration and size distribution in human knee synovial fluid: Variations with age and cartilage degeneration","volume":"18","author":"Ren","year":"2016","journal-title":"Arthritis Res. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s00256-020-03550-5","article-title":"Obese and overweight individuals have greater knee synovial inflammation and associated structural and cartilage compositional degeneration: Data from the osteoarthritis initiative","volume":"50","author":"Kanthawang","year":"2021","journal-title":"Skeletal. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.joca.2020.04.020","article-title":"Cartilage calcification is associated with histological degeneration of the knee joint: A highly prevalent, age-independent systemic process","volume":"28","author":"Hubert","year":"2020","journal-title":"Osteoarthritis Cartilage"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"155043","DOI":"10.1016\/j.cyto.2020.155043","article-title":"An update on the association between metabolic syndrome and osteoarthritis and on the potential role of leptin in osteoarthritis","volume":"129","author":"Gao","year":"2020","journal-title":"Cytokine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1111\/1756-185X.12611","article-title":"Potential role of age, sex, body mass index and pain to identify patients with knee osteoarthritis","volume":"20","author":"Pereira","year":"2017","journal-title":"Int. J. Rheum. Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/1\/27\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:52Z","timestamp":1760147332000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/1\/27"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,23]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["medicina59010027"],"URL":"https:\/\/doi.org\/10.3390\/medicina59010027","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2022,12,23]]}}}