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Kellgren and Lawrence Grading For

Osteoarthritis Radiographs
MANUAL-OA-04
Version
1.0

Effective Date
09-13-2011
Page 1 of 6

Kellgren and Lawrence Grading For Osteoarthritis Radiographs Page 1 of 6 MANUAL-OA-04 / v: 1.0 / ed: 09-13-11
Overview
The classification for osteoarthritis (OA) described by Kellgren and Lawrence (KL) is the most widely used
radiological classification to identify and grade OA. Kellgren and Lawrence defined OA in five grades (0,
normal to 4, severe). The radiological signs found to be evidence for OA were combined to define a
grading scale for severity. For the joint, important changes are:
(a) formation of osteophytes on the joint margins or in ligamentous attachments, as on the tibial
spines
(b) narrowing of joint space associated with sclerosis of subchondral bone
(c) cystic areas with sclerotic walls situated in the subchondral bone
(d) altered shape of the bone ends.
This reference manual provides the detail for radiologists reviewing knee radiographs for KL scoring.
Instructions
Follow the instructions below when performing KL scoring. Readers should note that knee position in
which the radiographs are obtained may result in different scores. Based on the standard for acquiring
knee radiographs at a given clinical site, semi-flexed knees can give a different KL appearance than
straight knees. The KL classification system is described below is not tuned on the position of the knee.
When reviewing knee radiographs for the extent of OA, follow these descriptions of the KL scoring
criteria. An anatomically normal knee is Grade 0.
Grade 1: doubtful narrowing of joint space and possible osteophytic lipping, also consider the
appearance of minute osteophytes of doubtful significance, possible osteophytes with or without
osteophyte lipping, but in general doubtful pathology.
Grade 2: definite osteophytes and possible narrowing of joint space, also consider the
appearance of a definite osteophyte and unimpaired joint space or possible joint space
narrowing, or minimal osteophytes with possible narrowing, cysts, and sclerosis.
Grade 3: moderate multiple osteophytes, definite narrowing of joint space and some sclerosis
and possible deformity of bone ends, also consider the appearance of moderate diminution of
joint space (with definite osteophytes) and/or definite narrowing, some sclerosis, and possible
bone contour deformity (bony attrition).
Grade 4: large osteophytes, marked narrowing of joint space, severe sclerosis and definite
deformity of bone ends, also consider the appearance of joint space greatly impaired with
sclerosis of subchondral bone, large osteophytes with severe joint space narrowing and/or bony
sclerosis and definite bone contour deformity (bony attrition).
Kellgren and Lawrence Grading For
Osteoarthritis Radiographs
MANUAL-OA-04
Version
1.0

Effective Date
09-13-2011
Page 2 of 6

Kellgren and Lawrence Grading For Osteoarthritis Radiographs Page 2 of 6 MANUAL-OA-04 / v: 1.0 / ed: 09-13-11
These grades can easily be applied to the knee, hip, and shoulder. Several example images follow:
Knee

1Knees with Kellgren-Lawrence (KL) scores of 14. A, Anteroposterior radiograph
shows knee in 62-year-old man with KL score of 1 with minimal osteophytes at lateral
tibial condyle (arrowhead). B, Anteroposterior radiograph shows knee in 74-year-old
man with KL score of 2 with small but definite osteophyte (arrowhead) and sharpening of
tibial spine (arrows) without reduction of joint space. C, Anteroposterior radiograph
shows knee in 35-year-old woman with KL score of 3 with definite narrowing of medial
joint space (arrow) and osteophyte (arrowhead). D, Anteroposterior radiograph shows
knee in 38-year-old woman with KL score of 4 with gross loss of lateral joint space (white
arrow), marked osteophytes (arrowheads), and sclerosis of subchondral bone (black
arrow).
Kellgren and Lawrence Grading For
Osteoarthritis Radiographs
MANUAL-OA-04
Version
1.0

Effective Date
09-13-2011
Page 3 of 6

Kellgren and Lawrence Grading For Osteoarthritis Radiographs Page 3 of 6 MANUAL-OA-04 / v: 1.0 / ed: 09-13-11
hip
KL1



KL2

Kellgren and Lawrence Grading For
Osteoarthritis Radiographs
MANUAL-OA-04
Version
1.0

Effective Date
09-13-2011
Page 4 of 6

Kellgren and Lawrence Grading For Osteoarthritis Radiographs Page 4 of 6 MANUAL-OA-04 / v: 1.0 / ed: 09-13-11
KL3

Kellgren and Lawrence Grading For
Osteoarthritis Radiographs
MANUAL-OA-04
Version
1.0

Effective Date
09-13-2011
Page 5 of 6

Kellgren and Lawrence Grading For Osteoarthritis Radiographs Page 5 of 6 MANUAL-OA-04 / v: 1.0 / ed: 09-13-11
KL4


Kellgren and Lawrence Grading For
Osteoarthritis Radiographs
MANUAL-OA-04
Version
1.0

Effective Date
09-13-2011
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Kellgren and Lawrence Grading For Osteoarthritis Radiographs Page 6 of 6 MANUAL-OA-04 / v: 1.0 / ed: 09-13-11
Revision History
Name Date Description of Changes Version
Mark W. Tengowski 2011-09-13 New radiograph scoring reference document. (Refer to
DRF# 3648).
1.0