Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren and Lawrence systems for the tibiofemoral joint in people aged 35- 54 years with chronic knee pain

Abstract

Objectives - To determine the prevalence of tibiofemoral radiographic knee osteoarthritis (OA) in people aged 35-54 years associated with chronic (> 3 months) knee pain using two different radiographic grading systems. Methods - Population based postal survey in a random sample of inhabitants in a district in southern Sweden followed by clinical examination and plain posteroanterior, weight bearing radiographical examination. The Ahlback criteria (focusing on joint space narrowing) and the Kellgren and Lawrence classification for knee OA were used for diagnosing tibiofemoral OA. Results - A questionnaire was sent to 2000 randomly selected people aged 35-54 years. The response rate was 92.6%. Fifteen per Cent of these people reported chronic knee pain. This group (n=279) was offered a clinical and radiographic examination of the knee joint and 204 persons agreed to participate. According to the Kellgren and Lawrence classification 28 subjects had OA of the knee grade 2 or more and 16 grade 3 or more. Radiographically detected OA of the knee according to Ahlback was found in 20 cases. The minimum prevalence of radiological tibiofemoral knee OA with knee pain was thus 1.5% for Kellgren and Lawrence grade 2 or more, 0.9% for grade 3 or more, and 1.1% according to the Ahlback classification. The agreement between the Kellgren and Lawrence grades 2-3 versus Ahlback grade I as well as grade 3-4 versus Ahlback grade I-II was good (κ 0.76 and 0.78 respectively). Conclusion - The prevalence of radiographic tibiofemoral OA combined with chronic knee pain in people aged 35-54 years was around 1% as estimated by either the Kellgren and Lawrence or the Ahlback classifications systems. Prospective follow up of this cohort should elucidate the significance of knee pain as a sign of developing OA.