Atlas of individual radiographic features in osteoarthritis

Last revised by Dr Joachim Feger on 29 Aug 2021

The atlas of individual radiographic features in osteoarthritis (OARSI atlas) are publications about radiographic features of osteoarthritis in different joints. They provide a grading scheme for those features illustrated by imaging examples 1,2.

The original and revised version of the OARSI atlas was written by Altmann et al. in 1995 and 2007 and features imaging characteristics of osteoarthritis such as osteophytes, joint space narrowing and other radiographic features for the hand, hip and knee 1,2.

Similar imaging findings were described and depicted in an atlas for foot joints written by Menz et al. in 2007 and for the ankle and hindfoot by Kraus et al. in 2015 3,4.

Radiographic features


The distal interphalangeal joints (DIP), proximal interphalangeal joints (PIP) as well as the first carpometacarpal joint (CMC) are evaluated and/or graded concerning the following radiographic features using imaging examples 2:

  • osteophyte formation (0-3)
  • joint space narrowing (0-3)
  • subluxation or malalignment
  • bone erosions
  • subchondral sclerosis
  • subchondral cysts

In addition, the scaphotrapeziotrapezoidal (STT) joint and the interphalangeal joint of the thumb are assessed for the presence or absence of osteophytes and joint space narrowing.


The following radiographic features are assessed and/or graded using imaging examples 2:

  • superior acetabular as well as superior and inferior femoral osteophytes (0-3)
  • superior and medial femoroacetabular joint space narrowing (0-3)

Additional radiographic features as the presence of an inferior acetabular osteophyte, subchondral cyst formation, femoral subchondral sclerosis, flattening of the femoral head and thickening of the medial femoral calcar are demonstrated with imaging examples.


Evaluation of the knee features the assessment and/or grading of the following 2:

  • medial and lateral femoral condyle as well as medial and lateral tibial plateau osteophytes (0-3)
  • medial and lateral compartment joint space narrowing (0-3)

Additional features are the presence of medial tibial attrition as well as medial tibial or femoral sclerosis.


The first metatarsophalangeal joint, the first and second cuneometatarsal joints the navicular-medial-cuneiform joint and the talonavicular joint are evaluated and graded on dorsoplantar and lateral foot radiographs concerning osteophyte formation (0-3) and joint space narrowing (0-3: none, definite, severe, joint fusion) 3.


The tibiotalar, fibulotalar and subtalar joints are evaluated and graded on the ankle (mortise view) and ankle (lateral view) radiographs for the following 4:

  • medial and lateral tibial, medial and lateral talar as well as distal fibular osteophytes (0-3)
  • medial and superior tibiotalar and fibulotalar joint space narrowing (0-3)
  • anterior and posterior tibiotalar osteophytes (0-3)
  • anterior and posterior tibiotalar joint space narrowing (0-3)
  • posterior talar osteophytes of the subtalar joint (0-3)
  • subtalar joint space narrowing (0-3)

In addition, the finding of subchondral sclerosis is evaluated and illustrated 4.

See also

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