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Elbow Osteoarthritis Classifications

classification elbow arthritis elbow osteoarthritis elbow radiographs elbow x-rays osteoarthritis
Elbow Osteoarthritis Classifications

Elbow Osteoarthritis Classifications

There are several radiological classification systems for elbow osteoarthritis. The most commonly used ones are:

Broberg and Morrey Classification3,8

This system is based on the formation of osteophytes and joint space narrowing:

  • Grade 0: Normal joint
  • Grade 1: Slight joint space narrowing with minimal osteophyte formation
  • Grade 2: Moderate joint space narrowing with moderate osteophyte formation
  • Grade 3: Severe degenerative changes with gross destruction of the joint. 

Hastings and Rettig Classification3,4,7

This system focuses on the presence of subluxation and involvement of the radiocapitellar joint:

  • Class I: Degenerative changes at the ulnohumeral joint margins with coronoid and olecranon spurring, but no radiocapitellar involvement
  • Class II: Class I features plus mild radiocapitellar joint space narrowing without radial head subluxation
  • Class III: Class II features plus radiocapitellar subluxation

Kellgren and Lawrence Classification5

Although originally developed for other joints, this system has been adapted for elbow osteoarthritis:

  • Grade 0: No radiographic features of osteoarthritis
  • Grade 1: Doubtful joint space narrowing and possible osteophytic lipping
  • Grade 2: Definite osteophytes and possible joint space narrowing
  • Grade 3: Moderate multiple osteophytes, definite narrowing of joint space, some sclerosis and possible deformity of bone ends
  • Grade 4: Large osteophytes, marked joint space narrowing, severe sclerosis and definite deformity of bone ends

 

These classification systems help in standardizing the assessment of elbow osteoarthritis severity and can guide treatment decisions. It's worth noting that while these systems are widely used, their reliability and correlation with clinical findings can vary, and they may not always accurately reflect the actual degree of cartilage degeneration within the joint.6

 

References

  1. Dalal S, Bull M, Stanley D. Radiographic changes at the elbow in primary osteoarthritis: a comparison with normal aging of the elbow joint. J Shoulder Elbow Surg. 2007;16(3):358-361. doi:10.1016/j.jse.2006.08.005
  2. Kwak JM, Kholinne E, Sun Y, Alhazmi AM, Koh KH, Jeon IH. Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment. Osteoarthritis Cartilage. 2019 Jul;27(7):1057-1063. doi: 10.1016/j.joca.2019.03.004. Epub 2019 Mar 25. PMID: 30922981.
  3. Amini MH, Sykes JB, Olson ST, et al. Reliability testing of two classification systems for osteoarthritis and post-traumatic arthritis of the elbow. J Shoulder Elbow Surg. 2015;24(3):353-357. doi:10.1016/j.jse.2014.10.015
  4. Kwak J-M, Jeon I-H. Surgical management for primary osteoarthritis of the elbow. Journal of Orthopaedic Surgery. 2021;29(1). doi:10.1177/2309499020988174
  5. KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502. doi:10.1136/ard.16.4.494
  6. Arthroscopic Validation of Radiographic Grading Scales of Osteoarthritis of the Tibiofemoral Joint. Richard Kijowski, Donna Blankenbaker, Paul Stanton, Jason Fine, and Arthur De Smet. American Journal of Roentgenology 2006 187:3, 794-799
  7. Rettig LA, Hastings H 2nd, Feinberg JR. Primary osteoarthritis of the elbow: lack of radiographic evidence for morphologic predisposition, results of operative debridement at intermediate follow-up, and basis for a new radiographic classification system. J Shoulder Elbow Surg. 2008 Jan-Feb;17(1):97-105. doi: 10.1016/j.jse.2007.03.014. Epub 2007 Nov 26. PMID: 18036842.
  8. Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986 Jun;68(5):669-74. PMID: 3722222.

 

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