Varus and valgus alignment and incident and progressive knee osteoarthritis

Abstract

Objective-Varus and valgus alignment increase, respectively, medial and lateral tibiofemoral load. Alignment was associated with tibiofemoral osteoarthritis progression in previous studies; an effect on risk of incident osteoarthritis is less certain. We tested whether alignment influences the risk of incident and progressive radiographic tibiofemoral osteoarthritis.Methods-In an observational, longitudinal study of the MOST (Multicenter Osteoarthritis Study) cohort, full-limb x-rays to measure alignment were acquired at baseline and knee x-rays were acquired at baseline and 30 months. Varus alignment was defined as ≤ 178° and valgus as ≥ 182°. Using logistic regression and GEE, we examined the association of baseline alignment and incident osteoarthritis at 30 months (in knees without osteoarthritis at baseline), and alignment and osteoarthritis progression (in knees with baseline osteoarthritis). All analyses were adjusted for age, gender, BMI, knee injury, laxity, and extensor strength, with neutral knees as referent.Results-2958 knees (1752 participants) were without osteoarthritis at baseline. Varus (adj. OR 1.49, 95% CI 1.06, 2.10) but not valgus alignment was associated with incident osteoarthritis. 1307 knees (950 participants) had osteoarthritis at baseline. Varus alignment was associated with a greater risk of medial osteoarthritis progression (adj. OR 3.59, 95% CI 2.62, 4.92) and a reduced risk of lateral progression, and valgus with a greater risk of lateral progression (adj. OR 4.85, 95% CI 3.17, 7.42) and a reduced risk of medial progression.Conclusion-Varus but not valgus alignment increased the risk of incident tibiofemoral osteoarthritis. In knees with osteoarthritis, varus and valgus alignment each increased the risk of progression in the biomechanically stressed compartment and reduced the risk of progression in the unloaded compartment.

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

“…Additionally, it has been our anecdotal observation that patients undergoing revision ACL reconstruction have varus malalignment more frequently than patients undergoing primary ACL reconstruction. If this is the case, preexisting medial tibiofemoral joint problems in the patients with failed ACL reconstruction can lead to more adverse consequences; varus malalignment is known to be one of the most important factors for progression of preexisting medial tibiofemoral OA and aggravation of symptoms [5,6,[18][19][20]22]. Moreover, in patients with large, irreparable medial meniscal tears, combined varus malalignment can further aggravate mechanical stress on the medial tibiofemoral joint and may result in early degeneration of the joint [3,7,13].…”

Normalization of Varus/Valgus Deformities in Osteoarthritis by External Application of Phytoconstituents: Confirmed With Anatomical Observations and Biochemical Profiles and Radiological Images

“…It has also been documented, valgus malalignment has been associated with an increase in the particular compartmental peak pressures laterally and medial area has continued to take more load than severe valgus malalignment, occurred by the lateral part [15,[17][18][19][20][21][22]. Sharma et al [16], have documented in their research that following three relations are closely obtained, malalignment increases in varus (as ≤178º) and valgus (as ≥182º), load increases in medial and lateral tibio-femoral bones and increases the development of knee OA. The terms valgus and varus refer to angulation (or bowing) within the shaft of a bone or at a joint.…”

“…[2,12]. The knee malalignment has been reported as major risk of knee osteoarthritis (OA) development in adult and malalignment is mainly dependent on valgus or varus alignment [13][14][15][16].…”

“…According to Sharma [15], it is very important to understand the biological mechanisms, in which difference between the impact of varus alignment and that of valgus alignment has not surprised to researchers [16] because these two alignments directly are interrelated with knee joints. It has been documented by several researchers that during gait in the neutrally aligned knee, load is disproportionately transmitted to medial tibio-femoral area.…”

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

“…Knee structure may be assessed clinically, in terms of flexion-extension range of motion (Flex-Ext ROM), malalignment, and other structural abnormalities using simple tools such as a goniometer [39]. Radiographically, the knee structure is assessed based on medial joint space (JS), tibiofemoral (TF) angle, and Kellgren-Lawrence (K-L) grade [41]; these are considered mechanical indicators of progression of knee OA [33,54,65,67,68]. Knee function may be assessed subjectively using validated questionnaires such as the KOOS [60] and objectively, using 3-D gait analysis that yields several kinematic and kinetic variables of dynamic knee function [26,49,56].…”