Systematic Review: Knee OA Progression Prediction with DL Shows Promising Internal AUC, But External Validation Drops to 0.75

External validation of knee OA progression DL models drops median AUC from 0.81 to 0.75; surgery prediction models (AUC 0.87) may reflect access to care, not disease, per review of 33 studies.

• Only 27% of studies performed external validation; 97% used the Osteoarthritis Initiative dataset.
• Combining imaging modalities (radiographs and MRI) did not consistently improve predictions, but models using longitudinal trajectories had higher internal performance.

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