The medial inclination of the proximal tibia is associated with the external knee adduction moment in advanced varus knee osteoarthritis

Abstract

Purpose Whether the inclined articular surface on the medial proximal tibia and the external knee adduction moment (KAM) correlate remains unclear. The hypothesis was that a steeper inclined articular surface correlated with a larger KAM in advanced knee osteoarthritis (OA). Methods A total of 44 females (non-OA, 9 knees; early OA, 14 knees; advanced OA, 21 knees; mean age, 58 ± 16 years) were examined. Three-dimensional (3D) assessment was used on biplanar long-leg radiographs and 3D bone models using a 3D to 2D image registration technique. The approximation plane in the proximal tibia was determined using the least-square method. The joint moments were mathematically calculated in a gait analysis, applying a motion capture system and force plates. The main evaluation parameters were the femorotibial angle (FTA), the coronal inclination of the approximation plane in the medial proximal tibia (coronal inclination), and internal knee joint moments. The KAM means the external moments balanced with the internal knee abduction moments. ResultsThe advanced OA showed a larger internal abduction moment (p = 0.017) at the loading response than the other groups. The larger FTA and steeper coronal inclination correlated with the larger internal abduction moment (FTA, p < 0.001; coronal inclination, p = 0.003) at the loading response. Conclusions As the clinical relevance, the association among the coronal inclination of the medial proximal tibia, lower extremity alignment, and KAM is one of the key factors to help better understand the etiology of knee OA. Level of evidence III.Keywords Knee osteoarthritis • Gait analysis • Inclined articular surface in the medial compartment of the proximal tibia • External knee adduction moment • Varus alignment

Association between the inclination angle of the proximal tibiofibular joint surface and medial compartment knee osteoarthritis

“…Therefore, early prevention and treatment is very important. The risk of medial compartment knee osteoarthritis could be assessed by age, body mass index, bone mineral density, lower extremity alignment (3)(4)(5), PTFJ inclination angle and other factors. Clinically, for middle-aged and elderly people with obesity, osteoporosis, knee varus, and low PTFJ inclination angles, early prevention of medial compartment knee osteoarthritis should be considered, including weight loss and antiosteoporosis (4,5).…”

“…Knee varus and medial compartment knee osteoarthritis are common in middle-aged and elderly patients, and always develop together (1,2). Knee varus and medial compartment knee osteoarthritis are affected by various factors, including biomechanical, genetic, and biological factors (3)(4)(5). Recent studies have shown the development of the two is related to the fibular support of the tibial plateau and bone settlement (6,7).…”

“…In the proximal tibia, fibular lateral support for the lateral tibial plateau results in nonuniform bone settlement of the tibial plateau, while bone settlement of the lateral tibial plateau is less severe than that of the medial tibial plateau. Nonuniform settlement leads to knee varus, increased external knee adduction moment and load increases in the medial compartment of the knee; knee varus, increased external knee adduction moment and load increases in the medial compartment of the knee, in turn, exacerbate nonuniform settlement and consequently create a negative cycle, which can provoke and aggravate medial compartment knee osteoarthritis (3,6,7).…”

A Strong Correlation Between the Severity of Flatfoot and Symptoms of Knee Osteoarthritis in 95 Patients

“…The association between the severity of flatfoot and knee OA is still unclear. In addition to knee pain and degeneration ( 8 ), knee malalignment ( 9 ), stiffness, and dysfunction ( 10 ) are also key factors for physicians when diagnosing knee OA. Thus, assessing the relationship between the characteristics of the knee and foot can help with accurate diagnosis and with devising a suitable correction plan.…”

Associations Between Periosteal Reaction of Proximal Tibial and Medial Compartment Knee Osteoarthritis

“…K nee osteoarthritis (KOA) is one of the most common joint disorders arising from multifactorial factors, including genetic component, gender, age, obesity, malalignment of the lower limb, and bone morphology [1][2][3][4] , which leads to functional impairment with a decreased physical activity level and often increases the risk of physical disability for patients 5 . Furthermore, KOA was generally regarded as a global public health problem and has the highest incidence rate between the ages of 55-65 years and poses an enormous socioeconomic burden worldwide 6,7 .…”