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Teachers’ knowledge of students’ misunderstandings (KOSM) is an essential theoretical component of teacher knowledge. Yet, the relationship between KOSM and student achievement is unclear. This study sampled 50 middle-school mathematics teachers and their students to investigate this relationship. It builds on previous methodology used to assess KOSM, asking teachers not only to predict common student misunderstandings but also to explain the source(s) of the misunderstanding(s). Latent class analysis and hierarchical linear modeling will be used to analyze teachers’ KOSM and investigate the relationship between teachers’ content knowledge, KOSM, background characteristics, and student achievement. This study provides a more refined measure of KOSM which may inform teacher development, providing evidence for or against the necessity of developing teachers’ KOSM.