The partnership for early knee OA definition through imaging and tissue biomarkers (PEARL-OA)

Objectives of the Project

Osteoarthritis (OA) is the fastest growing cause of disability worldwide. The development of OA structural and symptom-modifying therapy is hampered by the complex phenotypes of this disease and difficulties in accurate quantification of OA pathologies.

We used 2 existing, longitudinal cohorts, selected for «early» OA risk factors, and applied novel MRI analysis using active appearance models (Imorphics UK Ltd). We studied bone features associated with progression to clinical knee OA.

Facts and Figures

Project Lead
P Conaghan
University of Leeds
FOREUM pump prime grant: € 75.000

Meet the team

P Conaghan
University of Leeds
R Frobell
Lund University


Using the Swedish KANON cohort, an RCT which includes 121 individuals who experienced an acute anterior cruciate ligament (ACL) injury, we found that bone shape changes occur rapidly after ACL injury and are already evident at 3 months. These changes post-ACL tear are similar to those reported in established knee OA.

In the Osteoarthritis Initiative Cohort, we found that bone shape predicted progression to total joint replacement, and that bone shape was associated with prevalent frequent knee symptoms  but not incident symptoms.

On the basis of the 3D imaging biomarkers evolved through this grant, the applicants were  part of a successful IMI application, APPROACH-OA, which will utilise these biomarkers to further explore the relationship of bone to OA development and progression.


  • Bowes MA, Lohmander LS, Wolstenholme C, Vincent GR, Conaghan PG, Frobell RB. Marked and rapid change of bone shape in acutely ACL injured knees – an exploratory analysis of the KANON trial. Osteoarthritis and Cartilage, April 2019 Volume 27, Issue 4, Pages 638–645
    Read more
  • Barr AJ, Dube B, Hensor EM, Kingsbury SR, Peat G, Bowes MA, Sharples LD, Conaghan PG. The relationship between three-dimensional knee MRI bone shape and total knee replacement-a case control study: data from the Osteoarthritis Initiative. Rheumatology (Oxford) 2016;55(9):1585-93.
    Read more