Individuals with a large volume of effusion-synovitis and/or an alteration in infrapatellar fat pad signal intensity on MRI have an increased risk of developing accelerated knee osteoarthritis (OA). Using participants from the Osteoarthritis Initiative, three groups of individuals were compared (n = 125 per group): those with accelerated knee OA; those with knee OA; and those without knee OA. Patients with accelerated knee OA had an average of 44% more effusion-synovitis volume than those with knee OA or no knee OA 2 years before disease onset, and >50% had a change in infrapatellar fat pad signal intensity on MRI.