Radiographic assessment of leg alignment and grading of knee osteoarthritis: A critical review

Table 1 Summary of knee osteoarthritis grading scales

Scale type	Ref.	Pros	Cons	Uses
Global	Kellgren and Lawrence[67,69]	Widely used Adopted by the World Health Organization (1961) and at the 3rd International Symposium of Rheumatic Disease (1966) Moderate to excellent reliability	Multiple descriptions of the levels have been published Emphasizes osteophytes Poor sensitivity to change	Epidemiological studies Outcome measure (research) Clinical use
	Ahlbäck[65] Galli[91]	One version uses a template, placed over a radiograph, to show typical bone contour	Poor reliability Emphasizes joint space narrowing	Epidemiological studies
	Sundaram et al[68]		No psychometric testing Defines early OA as osteophytes only	Epidemiological study for knee OA after tibial dome osteotomy
	Brandt et al[66]	Good correlation to damage seen at arthroscopy	No reliability testing performed Emphasizes joint space narrowing	Classify participants for research studies
Composite	Satku et al[97]	Includes a variety of features of knee OA	No psychometric testing	Used in research to describe OA development after anterior cruciate ligament tears
	Kannus et al[96]	Includes many features of knee OA, in a variety of locations in the knee Good reliability	Very complicated	Used in research to describe OA development after anterior cruciate ligament tears
	McAlindon et al[99]	Moderate reliability Includes several compartments of the knee	Assesses both knees at once	Research on the association between knee pain, disability, strength and radiographic evidence of knee OA
	Merchant et al[98]	Includes several features of knee OA	No psychometric testing	Research on the onset of knee OA after ankle or lower leg injuries
	Compartmental grading scale for knee OA (CG) Cooke et al[100]	Includes several features of knee OA Excellent reliability		Epidemiological studies Part of the Knee Surgery Triage Tool
Individual	Osteoarthritis Research Society International atlas Altman et al[26]	Most commonly-used individual OA feature scale Moderate reliability	Often used to assess only joint space narrowing	Epidemiological studies Monitor progression of knee OA
	Thomas et al[110]		No psychometric testing
	Cooper et al[105]		No psychometric testing
	Spector et al[30,34,109] Braga et al[116] O'Reilly et al[117]	Fair to excellent reliability		Epidemiological studies Classify participants for intervention studies
	Scott feature based scoring system Scott et al[82]	Scores 8 different OA features Fair to excellent reliability		Epidemiological studies Outcome measure
	Nottingham logically derived line drawing atlas Nagaosa et al[107]	Line drawings are meant to avoid problems using radiographs in an atlas Moderate reliability		Epidemiological studies Outcome measure (research)
	Knee images digital analysis Marijnissen et al[130] Muraki et al[131]	Uses continuous scales Excellent reliability	Only good-quality radiographs can be used	Epidemiological studies
	Knee OA computer-aided diagnosis Oka et al[81]	Uses continuous scales Excellent reliability		Epidemiological studies

OA: Osteoarthritis.