A multimodal vision foundation model for generalizable knee pathology

Abstract

Musculoskeletal disorders represent a leading cause of global disability, creating an urgent demand for precise interpretation of medical imaging. Current artificial intelligence (AI) approaches in orthopedics predominantly rely on task-specific, supervised learning paradigms. These methods are inherently fragmented, require extensive annotated datasets, and often lack generalizability across different modalities and clinical scenarios. The development of foundation models in this field has been constrained by the scarcity of large-scale, curated, and open-source musculoskeletal datasets. To address these challenges, we introduce OrthoFoundation, a multimodal vision foundation model optimized for musculoskeletal pathology. We constructed a pre-training dataset of 1.2 million unlabeled knee X-ray and MRI images from internal and public databases. Utilizing a Dinov3 backbone, the model was trained via self-supervised contrastive learning to capture robust radiological representations. OrthoFoundation achieves state-of-the-art (SOTA) performance across 14 downstream tasks. It attained superior accuracy in X-ray osteoarthritis diagnosis and ranked first in MRI structural injury detection. The model demonstrated remarkable label efficiency, matching supervised baselines using only 50% of labeled data. Furthermore, despite being pre-trained on knee images, OrthoFoundation exhibited exceptional cross-anatomy generalization to the hip, shoulder, and ankle. OrthoFoundation represents a significant advancement toward general-purpose AI for musculoskeletal imaging. By learning fundamental, joint-agnostic radiological semantics from large-scale multimodal data, it overcomes the limitations of conventional models, which provides a robust framework for reducing annotation burdens and enhancing diagnostic accuracy in clinical practice.