Careful notekeeping allows a surgeon to follow the progression of knee damage, in order to intervene at the most appropriate time.
Page updated July 2023 by Dr Sheila Strover (Clinical Editor)
This Primer explains how joint (articular) cartilage damage can lead to osteoarthritis in the knee.
- Introduction to arthritis
- Types of arthritis
- The common arthritis pathway
- How knee arthritis progresses
- What's special about hyaline (articular) cartilage?
- Arthritis cysts and spurs
- Joint injections for knee arthritis
- The concept of arthritis compartments
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Classifying the amount of cartilage damage
- Knee X-rays and arthritis
Classification systems are used by doctors to assess the extent of arthritis in the joint.
A number of elements are deemed important when assessing what interventions might be helpful in trying to contain the arthritic process surgically:
Structural Classifications
Structural classifications record objectively the extent and depth of the joint cartilage damage. This helps the surgeon to follow the progression or improvement of the structural damage. A commonly used classification is the Outerbridge Classification:
- Grade 0: normal cartilage
- Grade I: cartilage with softening and swelling
- Grade II: partial-thickness defect with fissures on the surface that do not reach the underlying bone or exceed 1.5 cm in diameter
- Grade III: fissures to the level of underlyingbone in an area with a diameter more than 1.5 cm
- Grade IV: exposed underlying bone.
Functional Classifications
Functional classifications reflect the degree of disability suffered by the patient with joint damage, eg Lysholm score, WOMAC score.
Other classification systems
- Insall classification
- Goodfellow classification
- Casscells classification
- Ficat & Hungerford classification
- Cincinnati Knee Rating System
- SFA system
- ICRS system
- Hunt classification
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