No Investigation Needed
For a patient with typical knee osteoarthritis presenting with joint clicking, no investigation is required. 1
Clinical Diagnosis is Sufficient
Joint clicking is a common mechanical symptom in knee osteoarthritis and does not change management or indicate need for imaging. 1 The EULAR guidelines explicitly state that imaging is not required to make the diagnosis in patients with typical presentation of OA, which includes usage-related pain, short duration morning stiffness, age >40, and symptoms affecting one or a few joints. 1
Why Imaging is Not Indicated
Clicking does not predict treatment response: Current evidence shows that imaging features, including mechanical symptoms like clicking, do not predict non-surgical treatment response and imaging cannot be recommended for this purpose. 1
Clicking responds to conservative treatment: Mechanical symptoms such as clicking, catching, or intermittent "locking" sensations do NOT indicate need for surgery or investigation, as these symptoms respond equally well to conservative treatment. 2
Imaging abnormalities are common and often asymptomatic: Imaging abnormalities of OA are commonly seen especially with increasing age and do not correlate with symptoms. 1
When Investigation Would Be Appropriate
Imaging is only recommended if there is unexpected rapid progression of symptoms or change in clinical characteristics to determine if this relates to OA severity or an additional diagnosis. 1 Examples include:
- Sudden onset of severe pain inconsistent with typical OA progression 1
- New mechanical locking (true inability to extend the knee, not just clicking) 2
- Suspicion of alternative diagnosis such as inflammatory arthritis, fracture, or infection 1
Critical Pitfall to Avoid
Do not order imaging based on clicking alone, as this leads to unnecessary costs and may reveal incidental findings that do not change management. 1 The presence of clicking or catching on examination is not an indication for MRI or arthroscopy. 1, 2
Appropriate Management
The patient should receive conservative management including structured exercise therapy targeting quadriceps and hip strengthening, weight reduction if overweight, topical NSAIDs for pain control, and patient education. 1, 3, 4