Osteoarthritis imagingPub Date : 2025-12-01Epub Date: 2025-10-30DOI: 10.1016/j.ostima.2025.100379
Jack Consolini , Kevin M. Koch , Alissa J. Burge , Erwin Xia , Sharmila Majumdar , Garry E. Gold , Hollis G. Potter , Matthew F. Koff
{"title":"Exploratory analysis of infrapatellar fat pad MRI-based radiomics for detection of knee structure abnormalities in collegiate basketball players and swimmers","authors":"Jack Consolini , Kevin M. Koch , Alissa J. Burge , Erwin Xia , Sharmila Majumdar , Garry E. Gold , Hollis G. Potter , Matthew F. Koff","doi":"10.1016/j.ostima.2025.100379","DOIUrl":"10.1016/j.ostima.2025.100379","url":null,"abstract":"<div><h3>Objective</h3><div>Magnetic resonance imaging (MRI) based radiomic evaluation of the infrapatellar fat pad (IPFP) has been shown to predict knee osteoarthritis. As IPFP abnormalities can arise from sport-related injuries, this study evaluated whether qualitatively identified knee structure abnormalities in young athletes can be detected by IPFP MRI-based radiomics.</div></div><div><h3>Design</h3><div>Bilateral knee MRIs using Dixon fat-water decomposition techniques were obtained from 46 NCAA Division 1 collegiate 46 basketball players (26 male, 20 female) and 21 swimmers (10 male, 11 female). Board-certified musculoskeletal radiologists evaluated anatomic features and patellar height using the modified Noyes score and Caton-Deschamps index. IPFP volumes were segmented, and fat fraction was computed. Radiomic features were calculated within 2D overlapping patches extracted from the IPFP in the fat and water images separately. Cross-validated logistic regression models were developed using IPFP radiomic features as predictors of an athlete’s sport and the occurrence of cartilage lesions, tendinopathy, or bone abnormalities as observed on MRI. Mann-Whitney U tests evaluated differences in fat fraction between sports and knee structure abnormalities.</div></div><div><h3>Results</h3><div>The area under the receiver operating characteristic (ROC) curve (AUC; maximum 0.79) indicated that IPFP radiomics from fat-only images can differentiate between basketball and swimming athletes. Tendinopathy was identified (AUC = 0.68 ± 0.05) at larger patch sizes. Qualitative radiological assessments of cartilage lesions and bone abnormalities were not distinguished (AUC < 0.57). Fat fraction did not differ across sports or knee structure abnormality (p > 0.49, mean difference < 0.5%).</div></div><div><h3>Conclusions</h3><div>In the absence of inflammatory arthropathy, IPFP radiomics discriminated between sports but not cartilage lesions, tendinopathy, or bone abnormalities, suggesting structural adaptation to sport-specific loading. Abnormal IPFP signal intensity may not present in young athletes without traumatic injury or knee arthroscopy.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 4","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoarthritis imagingPub Date : 2025-12-01Epub Date: 2025-09-18DOI: 10.1016/j.ostima.2025.100373
Sahar Sawani , Liubov Arbeeva , Katherine A. Yates , Carolina Alvarez , Todd A. Schwartz , Serena Savage-Guin , Jordan B. Renner , Catherine J. Bakewell , Minna J. Kohler , Janice Lin , Jonathan Samuels , Amanda E. Nelson
{"title":"Patterns of shared variation in knee ultrasound for osteoarthritis: a machine learning approach","authors":"Sahar Sawani , Liubov Arbeeva , Katherine A. Yates , Carolina Alvarez , Todd A. Schwartz , Serena Savage-Guin , Jordan B. Renner , Catherine J. Bakewell , Minna J. Kohler , Janice Lin , Jonathan Samuels , Amanda E. Nelson","doi":"10.1016/j.ostima.2025.100373","DOIUrl":"10.1016/j.ostima.2025.100373","url":null,"abstract":"<div><h3>Objective</h3><div>To identify phenotypes of knee osteoarthritis (KOA) based on demographic and clinical variables, symptoms, and ultrasound (US) features using a novel machine learning (ML) approach.</div></div><div><h3>Design</h3><div>Participants in the Johnston County Health Study provided demographics, symptomatic and functional assessments, and joint radiographs, which were transformed into the clinical data block. Standardized knee US were obtained, and US features composed the second data block. The Angle-based Joint and Individual Variation Explained (AJIVE) algorithm was used to identify shared and individual modes of variation. We focused on shared structure to explore how US features and non-US clinical data varied together overall, and in the subset with radiographic KOA (rKOA).</div></div><div><h3>Results</h3><div>This analysis included 861 participants (mean age 55 years, mean BMI 33 kg/m<sup>2</sup>); 335 (39 %) had rKOA. AJIVE identified two components of shared variation (subgroup and SC2). SC1 associated osteophytes and cartilage damage on US with higher BMI, older age, and worse symptoms and outcome scores. SC2 correlated effusion and synovitis but less cartilage damage on US, with better physical function and lower BMI. A similar pattern was seen in those with rKOA.</div></div><div><h3>Conclusions</h3><div>We identified two shared directions of variation that may represent distinct phenotypes of KOA. The first is consistent with prior studies linking osteophytes and cartilage damage to worse symptoms and function. The second may represent an inflammatory subtype of KOA, with greater effusion and synovitis but less osteophytosis and cartilage damage. These clinically feasible phenotypes should be confirmed in future studies.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 4","pages":"Article 100373"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoarthritis imagingPub Date : 2025-12-01Epub Date: 2025-11-20DOI: 10.1016/j.ostima.2025.100384
Kaitlin G. Sofko , Ibukunoluwa O. Elebute , Lumeng Cui , Natasha M. Bzowey , Marianne S. Black , Emily J. McWalter
{"title":"Repeatability of focal changes in knee cartilage T2 relaxation times with load and time","authors":"Kaitlin G. Sofko , Ibukunoluwa O. Elebute , Lumeng Cui , Natasha M. Bzowey , Marianne S. Black , Emily J. McWalter","doi":"10.1016/j.ostima.2025.100384","DOIUrl":"10.1016/j.ostima.2025.100384","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study is to assess the repeatability of focal changes in T<sub>2</sub> relaxation time of knee articular cartilage with load and over time.</div></div><div><h3>Design</h3><div>A short-term repeatability study was conducted in five healthy participants. Images were acquired of the knee in an unloaded position and in loaded flexion with a custom, quantitative Double Echo Steady State (qDESS) MRI sequence on a 3T scanner. The protocol was carried out three times within a one-week period. T<sub>2</sub> relaxation maps of the tibial and femoral articular cartilage were created and focal areas of change were identified using a cluster-based analysis approach; the outcome measure was defined as the percentage area covered by a cluster of pixels that change with load or over time. Average T<sub>2</sub> relaxation time within anatomical regions was also calculated. Repeatability of the cluster-based and regional approach was described as the root mean square standard deviation (SDrms) of the trials.</div></div><div><h3>Results</h3><div>The SDrms of the percentage area of the entire cartilage surface covered by clusters when the knees were loaded was <9.5 %. The repeatability of the percentage area of the entire cartilage surface covered by clusters over time was <4.5 % for the unloaded knees and 7.4 % for the loaded knees. For the regional analysis, the average SDrms of the entire plate was <3.0 ms.</div></div><div><h3>Conclusion</h3><div>Cluster analysis provides important information on focal changes in cartilage with the application of load and over time, but at the cost of repeatability compared to regional approaches.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 4","pages":"Article 100384"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoarthritis imagingPub Date : 2025-12-01Epub Date: 2025-10-28DOI: 10.1016/j.ostima.2025.100376
Tijmen A. van Zadelhoff , Rianne A. van der Heijden , Sita M.A. Bierma-Zeinstra , P. Koen Bos , Edwin H.G. Oei
{"title":"Perspective: Genicular artery embolization for knee osteoarthritis - When the hype doesn’t match the evidence","authors":"Tijmen A. van Zadelhoff , Rianne A. van der Heijden , Sita M.A. Bierma-Zeinstra , P. Koen Bos , Edwin H.G. Oei","doi":"10.1016/j.ostima.2025.100376","DOIUrl":"10.1016/j.ostima.2025.100376","url":null,"abstract":"<div><div>This paper summarizes the current evidence on genicular artery embolization (GAE) for the treatment of knee osteoarthritis (OA). The goal of this minimally invasive treatment is to reduce synovitis by embolizing peri‑genicular neovascularization and subsequently alleviate pain. Multiple uncontrolled case series have generally demonstrated a promising efficacy of GAE with substantial, lasting pain reduction and improved function. However, these studies lack control groups, making it difficult to distinguish between treatment effect and placebo effect. Three sham-controlled randomized clinical trials (RCTs) have been published to date, with varying methodologies. While the first reported positive results, the most recent two RCTs reported no significant effect of GAE compared to a sham treatment. Moreover, systematic reviews have generally supported the efficacy of GAE but did not include the two most recent RCTs. Given the lack of robust evidence from updated systematic reviews including the most recent published studies, the growing clinical adoption of GAE is not justified and, in our opinion, premature.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 4","pages":"Article 100376"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoarthritis imagingPub Date : 2025-09-01Epub Date: 2025-06-09DOI: 10.1016/j.ostima.2025.100356
Hamid Harandi , Soheil Mohammadi , Ali Guermazi
{"title":"The 18th international workshop on osteoarthritis imaging. Structure and pain: Where are we today?","authors":"Hamid Harandi , Soheil Mohammadi , Ali Guermazi","doi":"10.1016/j.ostima.2025.100356","DOIUrl":"10.1016/j.ostima.2025.100356","url":null,"abstract":"<div><h3>Objective</h3><div>This paper provides a comprehensive overview of the key themes, new findings, and research directions highlighted during the keynote presentations and panel discussions at the IWOAI 2024.</div></div><div><h3>Design</h3><div>Comprehensive literature review of keynote lectures and submitted scientific abstracts presented during the 18th IWOAI held in Marrakesh, Morocco.</div></div><div><h3>Results</h3><div>The 18th International Workshop on Osteoarthritis Imaging (IWOAI) was held from June 25 to June 28, 2024, in Marrakesh, Morocco. The main theme of the workshop was Structure and Pain: Where Are We Today? Ten sessions covering various aspects of new concepts and strategies related to structure and pain in the imaging of osteoarthritis (OA) were held. These sessions included nine keynote presentations and oral presentations of abstracts, addressing different topics such as structural factors in OA, pain management challenges in OA-related trials, and imaging outcomes as endpoints in these trials. The final session was a round table featuring participants from diverse scientific and clinical fields who discussed their perspectives on the utility of imaging in OA.</div></div><div><h3>Conclusion</h3><div>The meeting successfully informed the radiology community about current advances, research, and future directions in osteoarthritis-related structure and pain through keynote speeches and oral presentations.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 3","pages":"Article 100356"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoarthritis imagingPub Date : 2025-09-01Epub Date: 2025-06-18DOI: 10.1016/j.ostima.2025.100358
Kalpana Sharma
{"title":"Quantitative meniscus imaging and analysis: A narrative review","authors":"Kalpana Sharma","doi":"10.1016/j.ostima.2025.100358","DOIUrl":"10.1016/j.ostima.2025.100358","url":null,"abstract":"<div><h3>Objective</h3><div>In this review, we summarize the literature on the evolution of magnetic resonance imaging (MRI), segmentation, and quantitative analysis (qMRI) of the meniscus, while bearing in mind the pivotal role of the meniscus in the development (incidence) and progression of symptomatic and structural knee osteoarthritis (KOA).</div></div><div><h3>Design</h3><div>We performed a literature search across PubMed and Google Scholar, spanning 35 years (1989–2024). We utilized keywords such as “meniscus”, “fibrocartilage”, “imaging”, “magnetic resonance”, “radiography”, “morphometry”, “quantitative analysis”, “knee”, “osteoarthritis”, “symptoms”, “pain”, “structure”, “progression”, “radiographic”, and “reproducibility”</div></div><div><h3>Results</h3><div>Technological advances in image acquisition, segmentation, and derivation of quantitative analytic endpoints pertinent to meniscus morphometry (e.g., height, width, and volume) and position (e.g., tibial coverage, extrusion area, and distance) within the joint are highlighted in the literature. Three-dimensional qMRI of the meniscus has emerged as a reliable and reproducible non-invasive measurement technology, offering enhanced efficacy for assessing the relationship of the meniscus with radiographic joint space width (JSW), knee pain, structural (radiographic) KOA status, and with symptomatic and structural progression of KOA. Quantitative measures of meniscal extrusion were found to be robust predictors of various imaging endpoints, including osteophyte formation, subchondral bone changes, cartilage loss, as well as significant clinical outcomes.</div></div><div><h3>Conclusions</h3><div>The emergence of quantitative meniscus measurement technology has revamped the field of meniscal imaging research, providing accurate 3D analysis of both morphometric and positional measures. The systematic application of this methodology has unveiled significant insights into a better understanding of the incidence and symptomatic and structural progression of KOA.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 3","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoarthritis imagingPub Date : 2025-09-01Epub Date: 2025-06-07DOI: 10.1016/j.ostima.2025.100272
Faysal Altahawi , Richard Lartey , Nancy Obuchowski , Xiaojuan Li , Carl S. Winalski
{"title":"Capturing deep partial-thickness cartilage loss with semiquantitative scoring: A supplemented MRI Osteoarthritis Knee Score (sMOAKS)","authors":"Faysal Altahawi , Richard Lartey , Nancy Obuchowski , Xiaojuan Li , Carl S. Winalski","doi":"10.1016/j.ostima.2025.100272","DOIUrl":"10.1016/j.ostima.2025.100272","url":null,"abstract":"<div><h3>Objective</h3><div>We propose a supplement to MOAKS (MRI Osteoarthritis Knee Score) for capturing >50 % partial thickness cartilage loss on knee MRI and measure reader agreement.</div></div><div><h3>Design</h3><div>MOAKS scores 2 severity levels of cartilage damage (any loss, full-thickness loss) within knee subregions with lesional area graded 0–3. We propose supplemented MOAKS (sMOAKS) by adding a similarly graded third level assessment for deep cartilage loss (DCL), >50 % thickness, in addition to traditional MOAKS for improved granularity of partial thickness cartilage loss. Using sMOAKS, two radiologists independently graded cartilage subscores for 40 knees and rescored 20 knees. Consolidated inter-reader and intra-reader agreement was calculated with kappa values for the DCL level supplement. To measure agreement for one example of a more granular combined sMOAKS outcome, coverage probability reader agreement was calculated for a scaled cartilage damage score (CDS), a summed normalized score (0–100) with equal weighting to articular surfaces combining subregion scores.</div></div><div><h3>Results</h3><div>DCL represented 27.8 % (63/227) of partial but not full-thickness cartilage loss subregion interpretations. Pooled subregion DCL involving >10 % surface area demonstrated 97.7 % (<em>ĸ</em> = 0.71) inter-reader agreement and 98.8 % (<em>ĸ</em> = 0.78) intra-reader agreement. For greatest subregion DCL size, weighted ĸ agreement was 0.73/0.82 (inter-reader/intra-reader) for articular surfaces and 0.75/0.83 for joint compartments. At 90 % CDS intra-reader agreement coverage, inter-reader CDS agreement values were 83 %, 82 %, and 78 % for surfaces, compartments, and whole joints, respectively.</div></div><div><h3>Conclusions</h3><div>There is substantial agreement for deep cartilage loss detection using sMOAKS across varied analysis methods. Further assessment will determine when the added granularity of sMOAKS is beneficial.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 3","pages":"Article 100272"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoarthritis imagingPub Date : 2025-06-01Epub Date: 2025-05-18DOI: 10.1016/j.ostima.2025.100271
Sheikh Muhammad Usman Shami , Nobuhiko Hata , Yan Epelboym
{"title":"Genicular artery embolization and nerve ablation: Interventional radiology solutions for osteoarthritis related knee pain","authors":"Sheikh Muhammad Usman Shami , Nobuhiko Hata , Yan Epelboym","doi":"10.1016/j.ostima.2025.100271","DOIUrl":"10.1016/j.ostima.2025.100271","url":null,"abstract":"<div><h3>Objective</h3><div>Osteoarthritis (OA) is a major cause of chronic knee pain, with treatment options ranging from conservative therapies to total knee replacement. Minimally invasive, image-guided interventions such as genicular artery embolization (GAE) and genicular nerve ablation (GNA) have emerged as alternatives for patients with refractory OA-related pain. This review explores these techniques and the role of interventional radiologists in multidisciplinary OA management.</div></div><div><h3>Design</h3><div>This narrative review synthesizes current evidence on the safety, efficacy, and technical aspects of GAE and GNA. GAE selectively embolizes genicular arteries supplying the knee joint and synovium, reducing synovitis by targeting abnormal neovascularity and hyperemia. The procedure is performed under fluoroscopic guidance and clinical studies have reported significant improvements in pain. GNA can be performed with ultrasound or fluoroscopic guidance. This technique utilizes radiofrequency ablation (RFA) to denervate sensory nerves thereby alleviating knee pain. Conventional, pulsed, and cooled RFA techniques are available and have demonstrated neuro-ablative effects.</div></div><div><h3>Results</h3><div>GAE and GNA have demonstrated high technical and clinical success, with significant reductions in Visual Analog Scale (VAS) pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and other patient reported outcome measures. Pain relief usually lasts from 6 to 12 months, with GAE benefits reported up to 24 months. Both procedures exhibit favorable safety profiles, with mostly mild, self-limiting adverse events.</div></div><div><h3>Conclusion</h3><div>GAE and GNA are effective minimally invasive options for patients who are not candidates for or unwilling to undergo knee replacement. Further randomized placebo-controlled trials are needed to confirm long-term efficacy for these interventions.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 2","pages":"Article 100271"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoarthritis imagingPub Date : 2025-06-01Epub Date: 2025-04-24DOI: 10.1016/j.ostima.2025.100270
Kamyar Moradi , Olga Kubassova , John A. Carrino
{"title":"Imaging of osteoarthritis-related bone marrow lesions in clinical trials","authors":"Kamyar Moradi , Olga Kubassova , John A. Carrino","doi":"10.1016/j.ostima.2025.100270","DOIUrl":"10.1016/j.ostima.2025.100270","url":null,"abstract":"<div><h3>Objective</h3><div>This narrative review aims to summarize current evidence regarding the imaging detection of bone marrow lesions (BMLs), their prognostic value for osteoarthritis (OA) progression and pain, as well as potential therapeutic interventions targeting BMLs in OA clinical trials.</div></div><div><h3>Design</h3><div>We performed a literature search in PubMed and Google Scholar for articles focusing on OA-related BMLs. Studies were included if they examined detection, pathophysiology, clinical significance, or treatments of knee BMLs. Non-OA etiologies (e.g., malignancy, rheumatologic diseases) were excluded.</div></div><div><h3>Results</h3><div>BMLs, present in approximately two-thirds of patients with knee OA, are considered key indicators of subchondral bone damage or microfracture. MRI is highly sensitive for detecting BMLs, using validated semi-quantitative and quantitative measurement methods. The lack of disease-modifying OA drugs has shifted interest toward targeting BMLs for potential therapeutic interventions. Clinical studies have shown that changes in BML volume can predict the subsequent incidence of OA in joints without established disease, and that their presence is associated with pain progression and structural deterioration when OA is already established. Potential treatments for OA-related BMLs include pharmacological agents that modify subchondral bone turnover, anti-inflammatory interventions, biomechanical stress reduction techniques, cellular therapies, dietary modifications, and surgical approaches.</div></div><div><h3>Conclusions</h3><div>A holistic and personalized approach is essential for advancing OA management and improving patient outcomes by effectively targeting BMLs. Incorporating patient-reported outcomes and quality-of-life measures, as well as considering combined treatment strategies, will strengthen future trials aimed at modifying BMLs.</div></div>","PeriodicalId":74378,"journal":{"name":"Osteoarthritis imaging","volume":"5 2","pages":"Article 100270"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}