Cartilage involvement in osteoarthritis ranges from subtle findings to extensive, easily detectable abnormalities [6-8]. Loss of clarity of the cartilage and loss of sharpness of the synovial space-cartilage interface are clearly evident features even in the absence of other US signs of cartilage damage. The integrity of the synovial space-cartilage interface is the main distinguishing feature of healthy subjects, when compared to patients with osteoarthritis (Fig. 4.1). Loss of cartilage transparency could reflect pathological changes such as fibrillation of cartilage and cleft formation.
Blurred and/or irregular margins together with marked cartilage thinning are the most common US findings in advanced osteoarthritis (Fig. 4.2 a,b).
Although standard criteria for assessing US changes in osteoarthritic condylar cartilage are not yet widely accepted, McCune et al.  have reported four main abnormalities in patients with knee osteoarthritis that can be regarded as US hallmarks of the disease at different stages. These include loss of cartilage transparency, reduced sharpness of the superficial cartilage margin, increased intensity of the deep cartilage margin and cartilage thinning [8-12].
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