Musculoskeletal Ultrasonography Versus Standing Radiography in Grading Knee Osteoarthritis: A Comparison Study Publisher



Yadolahi M ; Mohammadnia E ; Hedayat E ; Halabchi F
Source: Ultrasound Published:2026

Abstract

Aims: Musculoskeletal ultrasonography is an accessible imaging modality with potential utility in knee osteoarthritis. This study aims to compare the sonographic features of knee osteoarthritis with standing radiographic grading and to assess the association with pain severity. Methods: In this cross-sectional study, patients with knee osteoarthritis underwent knee ultrasonography and standing anteroposterior and lateral radiographs. Radiographs were independently assessed by a blinded reviewer and graded using the Kellgren–Lawrence system. Kellgren–Lawrence grades 1–2 were classified as mild osteoarthritis and grades 3–4 as moderate to severe osteoarthritis. Sonographic findings were compared with radiographic grades, and the association with pain severity measured by the visual analogue scale (VAS) was evaluated. Results: Sonographic measurements of medial femoral osteophytes, suprapatellar effusion, Baker’s cyst, and medial meniscal protrusion significantly correlated to radiographic osteoarthritis severity (p ⩽ 0.05). A composite score derived from these four variables demonstrated acceptable diagnostic performance (Youden index: 0.61). This composite score significantly correlated to VAS pain scores (p = 0.003), whereas VAS was not significantly associated with the Kellgren–Lawrence grade. Conclusion: Ultrasonography may serve as a valuable adjunct or alternative to plain radiography for estimating knee osteoarthritis severity and its clinical impact. Further well-designed studies are warranted to confirm these findings. © The Author(s) 2026