Unveiling the Vascular-metabolic Continuum in Knee Osteoarthritis: Insights from Ultrasonographic Assessment

Background: Knee osteoarthritis (KOA) is a significant global health concern. We aimed to evaluate the association between KOA and vascular alterations by assessing popliteal artery wall thickness (PAWT) and descending genicular artery peak systolic velocity (PSV-DGA) using ultrasonography, and to explore their relationship with metabolic health parameters. Methods: In this observational study conducted over 18 months, 154 participants (80 KOA patients with KL grade 3/4 and 74 healthy controls) were enrolled. Demographic data, body mass index (BMI), waist circumference, comorbidities, and Visual Analog Scale scores were recorded. Ultrasound was used to measure PAWT and PSV-DGA. Wilcoxon and receiver-operating characteristic (ROC) analyses compared variables and identified predictors. Multivariable logistic regression determined independent predictors of KOA. Results: KOA patients showed significantly increased PAWT (1.20 ± 0.26 mm vs. 0.59 ± 0.22 mm, P < 0.001), higher PSV-DGA (13.95 ± 7.83 cm/s vs. 6.99 ± 2.86 cm/s, P < 0.001), and greater joint effusion (6.38 ± 5.37 mm vs. 1.40 ± 1.96 mm, P = 0.003). ROC analysis demonstrated excellent diagnostic performance for PAWT (area under the curve [AUC] = 0.952) and good performance for PSV-DGA (AUC = 0.869) in predicting KOA. PAWT positively correlated with joint effusion (ρ = 0.27, P = 0.036). Multivariable analysis identified the PAWT wall thickness (adjusted odds ratio [aOR]=77,628.77; P < 0.001) and BMI (aOR = 1.09; P = 0.007) as independent predictors of KOA. Conclusion: Ultrasound-assessed PAWT and PSV-DGA were significantly elevated in KOA and correlated with joint inflammation and metabolic dysfunction. These findings support a vascular-metabolic component in KOA pathogenesis.