Chen ZG, Xu WQ, Zhang ZR, Liu JS, Xu YX. Letter to the Editor: Kellgren-Lawrence classification for knee osteoarthritis: Clinical value and limitations. World J Orthop 2026; 17(7): 115613 [DOI: 10.5312/wjo.115613]
Corresponding Author of This Article
Ying-Xing Xu, MD, Chief Physician, Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Wuhua District, Kunming 650000, Yunnan Province, China. 13708776227@163.com
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Orthopedics
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letter
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Chen ZG, Xu WQ, Zhang ZR, Liu JS, Xu YX. Letter to the Editor: Kellgren-Lawrence classification for knee osteoarthritis: Clinical value and limitations. World J Orthop 2026; 17(7): 115613 [DOI: 10.5312/wjo.115613]
Zhi-Guang Chen, Wen-Qian Xu, Zeng-Rui Zhang, Jin-Song Liu, Ying-Xing Xu, Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
Author contributions: Chen ZG and Xu YX designed the overall concept and outline of the manuscript; Chen ZG, Xu YX, Liu JS, Zhang ZR, and Xu WQ contributed to the discussion and design of the manuscript; and all authors have read and approved the final version to be published.
Conflict-of-interest statement: All authors declare no competing financial or non-financial interests for this article.
Corresponding author: Ying-Xing Xu, MD, Chief Physician, Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Wuhua District, Kunming 650000, Yunnan Province, China. 13708776227@163.com
Received: October 21, 2025 Revised: February 15, 2026 Accepted: April 23, 2026 Published online: July 18, 2026 Processing time: 263 Days and 7.3 Hours
Abstract
In this article, we provide a commentary on the article by Alshahrani et al published in the latest issue of World Journal of Orthopedics, with a particular focus on the clinical utility of the Kellgren-Lawrence (K-L) classification in the evaluation of knee osteoarthritis (KOA). The K-L classification serves as a reference standard for assessing the severity of KOA, informing stepwise treatment algorithms and supporting scientific research. It offers distinct clinical value. However, the clinical application of the K-L classification is subject to notable limitations, which stem from the inherent constraints of radiographic imaging, incompleteness of the grading criteria, and the frequent dissociation between structural changes and symptomatic manifestations in patients with KOA. Therefore, this article aims to critically examine the clinical applicability and limitations of the K-L classification in the assessment of KOA.
Core Tip: The Kellgren-Lawrence grading system remains a cornerstone for the radiographic assessment of knee osteoarthritis. Although invaluable for diagnosis, treatment stratification, and research, it has significant limitations. Key limitations include its dependency on radiographic imaging, inability to assess soft tissues or the patellofemoral joint, and variable correlation with subjective symptoms. A multimodal, patient-centered assessment strategy is recommended for optimal knee osteoarthritis evaluation.
