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Osteoarthritis Cartilage. 2003 Feb;11(2):149-50.

Kellgren & Lawrence grade 1 osteophytes in the knee--doubtful or definite?

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The Twin Research and Genetic Epidemiology Unit, St Thomas' Hospital, London, UK.


The most universally accepted methods of classification of radiographic osteoarthritis (OA) is the Kellgren & Lawrence (K&L) grading system. However, there have been many criticisms of this including the grading of a doubtful osteophyte as a grade 1. We report the natural history of a given prevalent grade 1 osteophyte in a 10-year follow-up knee study. 62% of women graded at baseline with a doubtful osteophyte went on to develop true osteophytic knee OA compared with only 22% of controls with no sign of disease. So called 'doubtful' osteophytes appear to be 'real' and significantly related to OA knee and therefore cannot be ignored or classified as normal.

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