Dynamic knee loads during gait predict proximal tibial bone distribution

Hurwitz, Debra E.; Sumner, Dale R.; Andriacchi, Thomas P.; Sugar, David A.

doi:10.1016/s0021-9290(98)00028-1

Cited by 267 publications

(182 citation statements)

References 21 publications

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“…This is consistent with some DXA studies of aBMD ratios (17,(49)(50)(51). However, it is important to note that medial: lateral ratios Ͼ1 are unable to distinguish between increased density on the medial side and decreased density on the lateral side.…”

Section: Discussionsupporting

confidence: 88%

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Bennell¹,

Creaby²,

Wrigley³

et al. 2008

Arthritis & Rheumatism

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Objective. Knee osteoarthritis (OA) is an organlevel failure of the joint involving pathologic changes in articular cartilage and bone. This cross-sectional study compared apparent volumetric bone mineral density (vBMD) of proximal tibial subchondral trabecular bone in people with and without knee OA, using peripheral quantitative computed tomography (pQCT).Methods. Seventy-five individuals with mild or moderate medial compartment knee OA and 41 asymptomatic controls were recruited. Peripheral QCT was used to measure vBMD of trabecular bone beneath medial and lateral tibiofemoral compartments at levels of 2% and 4% of tibial length, distal to the tibial plateau.Results. There was no significant difference in vBMD beneath the overall medial and lateral compartments between the 3 groups. However, in the affected medial compartment of those with moderate OA, lower vBMD was seen in the 2 posterior subregions compared with controls and those with mild knee OA, while higher vBMD was seen in the anteromedial subregion. Beneath the unaffected or lesser affected lateral compartment, significantly lower vBMD was seen at the 2% level in the anterior and lateral subregions of those with moderate disease. Volumetric BMD ratios showed relatively higher vBMD in the medial compartment compared with the lateral compartment, but these ratios were not influenced by disease status.Conclusion. Subregional vBMD changes were evident beneath the medial and lateral compartments of those with moderate medial knee OA. Of import, the posterior subchondral trabecular regions of the medial tibial plateau have markedly lower vBMD.

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Section: Discussionsupporting

confidence: 88%

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Bennell¹,

Creaby²,

Wrigley³

et al. 2008

Arthritis & Rheumatism

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“…18,19 This is exacerbated in varus malalignment, which has been associated with increased joint compression 20 and cartilage pressure, 21 as well as decreased cartilage thickness 22 and volume 9 and increased stiffness of the subchondral bone. 23 Biomechanical factors in varus malalignment include greater adduction moment 19 and medial ligament laxity 25 with a consequent increase in compensatory muscle contraction, 26 particularly by quadriceps motor units. 27 There is, however, a paucity of studies that have considered the association between knee malalignment and cartilage defects.…”

Section: Discussionmentioning

confidence: 99%

Static knee alignment is associated with the risk of unicompartmental knee cartilage defects

Janakiramanan

Teichtahl

Wluka

et al. 2007

Journal Orthopaedic Research

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Although knee malalignment is a risk factor for the progression of unicompartmental knee osteoarthritis (OA), it is unclear how this relationship is mediated. Cartilage defects are known to predate cartilage loss and the onset of knee OA, and it may be that knee malalignment increases the risk of unicompartmental knee cartilage defects. Knee radiographs and MRI were performed on a total of 202 subjects, 36.6% of whom had radiographic knee OA, to determine the relationship between static knee alignment and knee cartilage defects. Analyses were performed for the entire cohort, as well as for healthy and OA subgroups. For every 18 increase in a valgus direction, there was an associated reduced risk of the presence of cartilage defects in the medial compartment of subjects with knee OA (p ¼ 0.02), healthy subjects (p ¼ 0.002), and the combined (p < 0.001) group. Moreover, for every 18 increase in a valgus direction, there was an associated increased risk of the presence of lateral cartilage defects in the OA group (p ¼ 0.006), although the relationship between change toward genu valgum and lateral compartment cartilage defects did not persist for the healthy group (p ¼ 0.16). This cross-sectional study has demonstrated that knee alignment is associated with the risk for compartment specific knee cartilage defects in both healthy and arthritic people. Given that the natural history of cartilage volume reduction appears to be predated by the presence of cartilage defects, whether knee alignment affects the longitudinal progression from cartilage defects to cartilage loss requires further examination. ß

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“…All subjective measurements were correlated (|r| C 0.54) with one another (Table 3), as were most of the objective measurements (|r| C 0.56) except for the peak knee adduction moment which did not correlate with any variable. The lack of correlation of the peak adduction moment to VAS knee pain and other variables was puzzling as it was contrary to the expected outcomes based on several previous reports [29,30,36,37]. However, other researchers also have observed a lack of correlation of knee adduction moment with knee pain, and other variables pertinent in knee OA.…”

Section: Discussionmentioning

confidence: 61%

“…However, substantial discordance also has been observed between the severity of patient's symptoms, and radiographic evidence of degenerative changes in knee OA (including JS narrowing). [7,19,27,62] Likewise, peak knee adduction moment during gait has been correlated with medial knee OA pain [36,63], varus alignment [17], mechanical axis [52], load distribution [5,36], compartmental bone mineral content [37], and radiographic evidence of disease progression [4,50,66]. However, conflicting reports exist related to knee adduction moment.…”

Section: Discussionmentioning

confidence: 99%

Are Joint Structure and Function Related to Medial Knee OA Pain? A Pilot Study

Zifchock

Kirane

Hillstrom

2011

Clinical Orthopaedics &Amp; Related Research

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Background Although the severity of knee osteoarthritis (OA) usually is assessed using different measures of joint structure, function, and pain, the relationships between these measures are unclear. Purpose Therefore, we: (1) examined the relationships between the measures of knee structure (flexion-extension range of motion, radiographic tibiofemoral angle, and medial joint space), function (Knee Osteoarthritis Outcome Scores [KOOS], peak adduction angle, and moment), and pain (visual analog scale [VAS]); and (2) identified variables that best predicted knee pain. Methods We assessed 15 patients with medial knee OA using VAS pain, KOOS questionnaire, 3-D gait analysis, and radiographic examination. Parameter relationships were assessed using Pearson correlation, and variables most predictive of knee pain were determined using a stepwise multiple regression. Results Subjective measurements correlated (|r| C 0.54) with one another, as did most of the objective measurements (|r| C 0.56) except for adduction moment which did not correlate with any variable. All variables correlated (|r| [ 0.54) with VAS knee pain except peak adduction moment. Medial joint space and peak adduction angle best predicted knee pain, accounting for approximately threequarters of the model variance (r 2 = 0.73).

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Dynamic knee loads during gait predict proximal tibial bone distribution

Cited by 267 publications

References 21 publications

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Static knee alignment is associated with the risk of unicompartmental knee cartilage defects

Are Joint Structure and Function Related to Medial Knee OA Pain? A Pilot Study

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