Impact of quantified knee positioning on the measurement of minimal joint space width using statistical shape models: A cross-sectional and longitudinal analysis in the IMI-APPROACH.

Eva Bax; Chien Nguyen; Roel Custers; Vahid Arbabi; Hassan Rayegan; Willem Paul Gielis; Claudia Lindner; Tim F. Cootes; Margreet Kloppenburg; Francisco J Blanco; Ida K Haugen; Francis Berenbaum; Mylène P. Jansen; Simon Mastbergen; Frank W Roemer; Felix Eckstein; Wolfgang Wirth; MC Kruyt; H Weinans

doi:10.1016/j.ostima.2025.100357

Impact of quantified knee positioning on the measurement of minimal joint space width using statistical shape models: A cross-sectional and longitudinal analysis in the IMI-APPROACH.

Eva Bax
, Chien Nguyen
, Roel Custers
, Vahid Arbabi
, Hassan Rayegan
, Willem Paul Gielis
, Claudia Lindner
, Tim F. Cootes
, Margreet Kloppenburg
, Francisco J Blanco
, Ida K Haugen
, Francis Berenbaum
, Mylène P. Jansen
, Simon Mastbergen
, Frank W Roemer
, Felix Eckstein
, Wolfgang Wirth
, MC Kruyt
, H Weinans

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Abstract: Objective
Correlations between minimum joint space width (mJSW) and MRI-based cartilage thickness are strong in cross-sectional analyses and moderate in longitudinal analyses, possibly due to knee rotation and flexion. This study investigates the effect of knee positioning during radiographic acquisition on the difference between mJSW and MRI-based cartilage thickness.
Methods
Radiographic mJSW from the index knee was determined from baseline (265 patients) and 24-month follow-up (165 patients) on fixed-flexion radiographs from IMI-APPROACH (multicenter OA study) patients using automated software. Statistical Shape Models were used to quantify knee rotation and flexion on radiographs. Cartilage thickness was assessed by manual segmentation from MRI. Differences between mJSW (radiographs) and cartilage thickness (MRI) were assessed at baseline and follow-up. Multivariable linear regression was used to evaluate the impact of knee flexion and rotation on the difference between mJSW and cartilage thickness.
Results
In cross-sectional analysis, differences between X-ray and MRI were significantly influenced by knee rotation (β = -0.18, P < 0.001). Longitudinal change in differences between X-ray and MRI were associated with changes in knee flexion (β = 0.19, P=0.002). Increases of one standard deviation in internal rotation and extension at follow-up resulted in a 0.2 mm false surrogate measurement of cartilage changes on radiographs.
Conclusion
Quantified knee positioning significantly affects differences between mJSW measured on radiographs and MRI-based cartilage thickness. The longitudinal analyses revealed that knee flexion was related to these differences, while knee rotation was only related to cross-sectional differences. These findings highlight the importance of knee positioning during radiographic acquisition in contributing to false surrogate measurement of cartilage status and cartilage change.

Original language	English
Article number	100357
Journal	Osteoarthritis Imaging
Volume	5
Issue number	4
DOIs	https://doi.org/10.1016/j.ostima.2025.100357
Publication status	Published - 2025

Keywords

Knee positioning
Minimum joint space width
Statistical shape models
Cartilage thickness
Knee osteoarthritis

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1-s2.0-S2772654125000972-mainFinal published version, 1.89 MBLicence: CC BY

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Bax, E., Nguyen, C., Custers, R., Arbabi, V., Rayegan, H., Gielis, W. P., Lindner, C., Cootes, T. F., Kloppenburg, M., Blanco, F. J., Haugen, I. K., Berenbaum, F., Jansen, M. P., Mastbergen, S., Roemer, F. W., Eckstein, F., Wirth, W., Kruyt, MC., & Weinans, H. (2025). Impact of quantified knee positioning on the measurement of minimal joint space width using statistical shape models: A cross-sectional and longitudinal analysis in the IMI-APPROACH. Osteoarthritis Imaging, 5(4), Article 100357. https://doi.org/10.1016/j.ostima.2025.100357

@article{decb50344be74a949bfd3c3c0b4ce170,

title = "Impact of quantified knee positioning on the measurement of minimal joint space width using statistical shape models: A cross-sectional and longitudinal analysis in the IMI-APPROACH.",

abstract = "Abstract: Objective Correlations between minimum joint space width (mJSW) and MRI-based cartilage thickness are strong in cross-sectional analyses and moderate in longitudinal analyses, possibly due to knee rotation and flexion. This study investigates the effect of knee positioning during radiographic acquisition on the difference between mJSW and MRI-based cartilage thickness. Methods Radiographic mJSW from the index knee was determined from baseline (265 patients) and 24-month follow-up (165 patients) on fixed-flexion radiographs from IMI-APPROACH (multicenter OA study) patients using automated software. Statistical Shape Models were used to quantify knee rotation and flexion on radiographs. Cartilage thickness was assessed by manual segmentation from MRI. Differences between mJSW (radiographs) and cartilage thickness (MRI) were assessed at baseline and follow-up. Multivariable linear regression was used to evaluate the impact of knee flexion and rotation on the difference between mJSW and cartilage thickness. Results In cross-sectional analysis, differences between X-ray and MRI were significantly influenced by knee rotation (β = -0.18, P < 0.001). Longitudinal change in differences between X-ray and MRI were associated with changes in knee flexion (β = 0.19, P=0.002). Increases of one standard deviation in internal rotation and extension at follow-up resulted in a 0.2 mm false surrogate measurement of cartilage changes on radiographs. Conclusion Quantified knee positioning significantly affects differences between mJSW measured on radiographs and MRI-based cartilage thickness. The longitudinal analyses revealed that knee flexion was related to these differences, while knee rotation was only related to cross-sectional differences. These findings highlight the importance of knee positioning during radiographic acquisition in contributing to false surrogate measurement of cartilage status and cartilage change. ",

keywords = "Knee positioning, Minimum joint space width, Statistical shape models, Cartilage thickness, Knee osteoarthritis",

author = "Eva Bax and Chien Nguyen and Roel Custers and Vahid Arbabi and Hassan Rayegan and Gielis, \{Willem Paul\} and Claudia Lindner and Cootes, \{Tim F.\} and Margreet Kloppenburg and Blanco, \{Francisco J\} and Haugen, \{Ida K\} and Francis Berenbaum and Jansen, \{Myl{\`e}ne P.\} and Simon Mastbergen and Roemer, \{Frank W\} and Felix Eckstein and Wolfgang Wirth and MC Kruyt and H Weinans",

year = "2025",

doi = "10.1016/j.ostima.2025.100357",

language = "English",

volume = "5",

journal = "Osteoarthritis Imaging",

issn = "2772-6541",

number = "4",

}

Bax, E, Nguyen, C , Custers, R , Arbabi, V, Rayegan, H, Gielis, WP, Lindner, C, Cootes, TF, Kloppenburg, M, Blanco, FJ, Haugen, IK, Berenbaum, F, Jansen, MP , Mastbergen, S, Roemer, FW, Eckstein, F, Wirth, W, Kruyt, MC & Weinans, H 2025, 'Impact of quantified knee positioning on the measurement of minimal joint space width using statistical shape models: A cross-sectional and longitudinal analysis in the IMI-APPROACH.', Osteoarthritis Imaging, vol. 5, no. 4, 100357. https://doi.org/10.1016/j.ostima.2025.100357

TY - JOUR

T1 - Impact of quantified knee positioning on the measurement of minimal joint space width using statistical shape models: A cross-sectional and longitudinal analysis in the IMI-APPROACH.

AU - Bax, Eva

AU - Nguyen, Chien

AU - Custers, Roel

AU - Arbabi, Vahid

AU - Rayegan, Hassan

AU - Gielis, Willem Paul

AU - Lindner, Claudia

AU - Cootes, Tim F.

AU - Kloppenburg, Margreet

AU - Blanco, Francisco J

AU - Haugen, Ida K

AU - Berenbaum, Francis

AU - Jansen, Mylène P.

AU - Mastbergen, Simon

AU - Roemer, Frank W

AU - Eckstein, Felix

AU - Wirth, Wolfgang

AU - Kruyt, MC

AU - Weinans, H

PY - 2025

Y1 - 2025

N2 - Abstract: Objective Correlations between minimum joint space width (mJSW) and MRI-based cartilage thickness are strong in cross-sectional analyses and moderate in longitudinal analyses, possibly due to knee rotation and flexion. This study investigates the effect of knee positioning during radiographic acquisition on the difference between mJSW and MRI-based cartilage thickness. Methods Radiographic mJSW from the index knee was determined from baseline (265 patients) and 24-month follow-up (165 patients) on fixed-flexion radiographs from IMI-APPROACH (multicenter OA study) patients using automated software. Statistical Shape Models were used to quantify knee rotation and flexion on radiographs. Cartilage thickness was assessed by manual segmentation from MRI. Differences between mJSW (radiographs) and cartilage thickness (MRI) were assessed at baseline and follow-up. Multivariable linear regression was used to evaluate the impact of knee flexion and rotation on the difference between mJSW and cartilage thickness. Results In cross-sectional analysis, differences between X-ray and MRI were significantly influenced by knee rotation (β = -0.18, P < 0.001). Longitudinal change in differences between X-ray and MRI were associated with changes in knee flexion (β = 0.19, P=0.002). Increases of one standard deviation in internal rotation and extension at follow-up resulted in a 0.2 mm false surrogate measurement of cartilage changes on radiographs. Conclusion Quantified knee positioning significantly affects differences between mJSW measured on radiographs and MRI-based cartilage thickness. The longitudinal analyses revealed that knee flexion was related to these differences, while knee rotation was only related to cross-sectional differences. These findings highlight the importance of knee positioning during radiographic acquisition in contributing to false surrogate measurement of cartilage status and cartilage change.

AB - Abstract: Objective Correlations between minimum joint space width (mJSW) and MRI-based cartilage thickness are strong in cross-sectional analyses and moderate in longitudinal analyses, possibly due to knee rotation and flexion. This study investigates the effect of knee positioning during radiographic acquisition on the difference between mJSW and MRI-based cartilage thickness. Methods Radiographic mJSW from the index knee was determined from baseline (265 patients) and 24-month follow-up (165 patients) on fixed-flexion radiographs from IMI-APPROACH (multicenter OA study) patients using automated software. Statistical Shape Models were used to quantify knee rotation and flexion on radiographs. Cartilage thickness was assessed by manual segmentation from MRI. Differences between mJSW (radiographs) and cartilage thickness (MRI) were assessed at baseline and follow-up. Multivariable linear regression was used to evaluate the impact of knee flexion and rotation on the difference between mJSW and cartilage thickness. Results In cross-sectional analysis, differences between X-ray and MRI were significantly influenced by knee rotation (β = -0.18, P < 0.001). Longitudinal change in differences between X-ray and MRI were associated with changes in knee flexion (β = 0.19, P=0.002). Increases of one standard deviation in internal rotation and extension at follow-up resulted in a 0.2 mm false surrogate measurement of cartilage changes on radiographs. Conclusion Quantified knee positioning significantly affects differences between mJSW measured on radiographs and MRI-based cartilage thickness. The longitudinal analyses revealed that knee flexion was related to these differences, while knee rotation was only related to cross-sectional differences. These findings highlight the importance of knee positioning during radiographic acquisition in contributing to false surrogate measurement of cartilage status and cartilage change.

KW - Knee positioning

KW - Minimum joint space width

KW - Statistical shape models

KW - Cartilage thickness

KW - Knee osteoarthritis

U2 - 10.1016/j.ostima.2025.100357

DO - 10.1016/j.ostima.2025.100357

M3 - Article

SN - 2772-6541

VL - 5

JO - Osteoarthritis Imaging

JF - Osteoarthritis Imaging

IS - 4

M1 - 100357

ER -

Impact of quantified knee positioning on the measurement of minimal joint space width using statistical shape models: A cross-sectional and longitudinal analysis in the IMI-APPROACH.

Abstract

Keywords

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