Heterogeneity of cartilage damage in Kellgren and Lawrence grade 2 and 3 knees: the MOST study

This paper by Dr. Roemer and other BICL team members describes in detail why radiography is not useful in screening patients for DMOAD trials. Commonly radiographic OA Kellgren-Lawrence 2 and 3 is included. However, these two grades of supposedly early-to-moderate knee OA reflect a wide spectrum of disease severity as shown in this analysis based on the observational Multicenter Osteoarthritis Study (MOST). Using radiography as a screening instrument will lead to inclusion of many knees without any cartilage damage, particularly in KL2 knees, and those with far advanced disease and complete cartilage denudation in large areas of the joint, particularly in KL3 knees. The data presented in this study calls for a more tailored screening effort on DMOAD trials using MRI as the modality of choice.