Varus thrust during walking and the risk of incident and worsening medial tibiofemoral MRI lesions: the Multicenter Osteoarthritis Study

Wink, Alexandra E.; Gross, K.D.; Brown, Carrie; Guermazi, Ali; Roemer, Frank W.; Niu, Jingbo; Torner, James C.; Lewis, C.E.; Nevitt, Michael C.; Tolstykh, Irina; Sharma, Leena; Felson, David T.

doi:10.1016/j.joca.2017.01.005

Cited by 50 publications

(39 citation statements)

References 29 publications

(44 reference statements)

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“…Previous work has shown an association between varus thrust and incident and worsening medial bone marrow lesions . Bone marrow lesions, thought to be related to bone trauma, are strongly associated with the presence of pain in knee OA .…”

Section: Discussionmentioning

confidence: 98%

“…Covariates for this study were selected to account for demographic or anatomic factors previously shown to differ between those with and those without thrust or to account for potential sources of variability in the data collection process . Age, sex, and race were self‐reported by MOST participants.…”

Section: Methodsmentioning

confidence: 99%

“…The relation of varus thrust to structural damage at the knee has been well‐documented. Varus thrust has been previously linked to increased odds of medial radiographic OA disease progression , increased odds of worsening medial tibiofemoral cartilage damage and incident and worsening bone marrow lesions , and prevalent patellofemoral OA . Importantly, knee thrust can be identified visually in a clinical setting, and evidence suggests that thrust may be modified using inexpensive and noninvasive therapies .…”

Section: Introductionmentioning

confidence: 99%

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Association of Varus Knee Thrust During Walking With Worsening Western Ontario and McMaster Universities Osteoarthritis Index Knee Pain: A Prospective Cohort Study

Wink

Gross

Brown

et al. 2019

Arthritis Care & Research

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Objective. To investigate the 2-year association of varus knee thrust observed during walking to the odds of worsening Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain in older adults with or at risk of osteoarthritis (OA).Methods. Video recordings of self-paced walking trials of Multicenter Osteoarthritis Study participants were assessed for the presence of varus thrust at baseline. Knee pain was assessed using the WOMAC questionnaire at baseline and at 2 years. Logistic regression was used to estimate the odds of worsening knee pain (defined as either any increase in WOMAC score or as clinically important worsening), adjusting for age, sex, race, body mass index, clinic site, gait speed, and static knee alignment. Analyses were repeated, stratified by baseline radiographic OA status and among the subset of knees without baseline WOMAC pain.Results. A total of 1,623 participants contributed 3,204 knees. Varus thrust was observed in 31.5% of knees. Knees with varus thrust had 1.44 times (95% confidence interval [95% CI] 1.19-1.73) the odds of any worsening and 1.37 times (95% CI 1.11-1.69) the odds of clinically important worsening WOMAC pain compared to knees without thrust. Knees with thrust without baseline WOMAC pain had 2.01 times (95% CI 1.47-2.74) the odds of incident total pain.Conclusion. Results indicate that varus thrust is a risk factor for worsening and incident knee pain. Targeting varus thrust through noninvasive therapies could prevent development or worsening of knee pain in older adults with or at risk for knee OA.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Varus Knee Thrust During Walking With Worsening Western Ontario and McMaster Universities Osteoarthritis Index Knee Pain: A Prospective Cohort Study

Wink

Gross

Brown

et al. 2019

Arthritis Care & Research

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“…Wink et al recently reported, in MOST participants with a range of OA severity, that varus thrust visually assessed by high-speed video was associated with increased risk of incident bone marrow lesions (but not incident medial cartilage loss), worsening bone marrow lesions, and worsening medial cartilage loss, findings that persisted in varus knees examined separately. 18 Our finding of an association of thrust with progression but not incident OA in the same study may relate to the healthier state of knees at risk for incident OA (vs. knees with OA). While static varus alignment has been found to be associated with both incident and progressive OA (which the current study confirms), the magnitude appears stronger for progression.…”

Section: Discussionmentioning

confidence: 64%

“…To our knowledge, there has been no previous report concerning thrust and incident radiographic OA. Wink et al recently reported, in Multicenter Osteoarthritis Study participants with a range of OA severity, that varus thrust visually assessed by high-speed video was associated with increased risk of incident bone marrow lesions (but not incident medial cartilage loss), worsening bone marrow lesions, and worsening medial cartilage loss, findings that persisted in varus knees examined separately (18). Our finding of an association of thrust with progression but not with incident OA in the same study may relate to the healthier state of knees at risk of incident OA (versus knees with OA).…”

Section: Discussionmentioning

confidence: 99%

Varus Thrust and Incident and Progressive Knee Osteoarthritis

Sharma

Chang

Jackson

et al. 2017

Arthritis & Rheumatology

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Background To determine if varus thrust, bowing-out of the knee during gait, i.e., the first appearance or worsening of varus alignment during stance, is associated with incident and progressive knee osteoarthritis (OA), we undertook an Osteoarthritis Initiative ancillary study. We further considered hypothesized associations adjusted for static alignment, anticipating some attenuation. Methods 2–3 trained examiners/site at 4 sites observed gait. In eligible knees, incident OA was analyzed as subsequent incident KL≥2, whole and partial-grade medial joint space narrowing (JSN), and annualized loss of joint space width (JSW), and progression as medial JSN and JSW loss. Outcomes were assessed over up to 7 years of follow-up. Analyses were knee-level, using multivariable logistic and linear regression with GEE to account for between-limb correlation. Results The incident OA sample included 4187 knees/2610 persons; the progression sample included 3421 knees/2284 persons. In knees with OA, thrust was associated with progression by each outcome adjusting for age, gender, BMI, and pain. In knees without OA, varus thrust was not associated with incident OA or other outcomes. After adjustment for alignment, the thrust/progression association was attenuated but an independent association persisted for partial grade JSN and JSW loss outcome models. WOMAC Pain and alignment were consistently associated with all outcomes. Within the stratum of varus knees, thrust was associated with an increased risk of progression. Conclusions Varus thrust visualized during gait is associated with knee OA progression and should be a target of intervention development.

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Relationship Between Varus Thrust During Gait and Low Back Pain in Individuals With Knee Osteoarthritis

Iijima

Suzuki

Aoyama

et al. 2020

Arthritis Care & Research

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Objective To test the hypothesis that varus thrust visualized during gait is associated with a higher prevalence of low back pain (LBP) in individuals with knee osteoarthritis (OA). Methods Individuals with knee OA (Kellgren/Lawrence grade ≥1) underwent a gait observation to assess varus thrust. The participants identified LBP and its severity using questionnaires. Logistic regression analyses were performed to examine the association between varus thrust and LBP. Results We included 205 participants (mean age 68.19 years; 72.20% women). A total of 45 participants (22.0%) showed varus thrust in their painful knee, in whom 31 (68.89%) and 18 (40.00%) were identified as having any LBP and moderate‐to‐severe LBP (numerical rating scale ≥4 points), respectively. Patients with varus thrust demonstrated a 3.6‐fold higher risk of the presence of moderate‐to‐severe LBP (95% confidence interval [95% CI] 1.62–8.10). In patients with LBP, the presence of varus thrust was associated with more severe LBP intensity (proportional odds ratio 2.25 [95% CI 1.02–4.96]). Conclusion This study highlights the novel relationship between varus thrust and LBP, which supports the idea of a biomechanical link, the so‐called knee–spine syndrome. These findings provide new insight for clarifying the pathogenesis of LBP related to knee OA.

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Varus thrust during walking and the risk of incident and worsening medial tibiofemoral MRI lesions: the Multicenter Osteoarthritis Study

Cited by 50 publications

References 29 publications

Association of Varus Knee Thrust During Walking With Worsening Western Ontario and McMaster Universities Osteoarthritis Index Knee Pain: A Prospective Cohort Study

Association of Varus Knee Thrust During Walking With Worsening Western Ontario and McMaster Universities Osteoarthritis Index Knee Pain: A Prospective Cohort Study

Varus Thrust and Incident and Progressive Knee Osteoarthritis

Relationship Between Varus Thrust During Gait and Low Back Pain in Individuals With Knee Osteoarthritis

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