Document Detail

Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative.
MedLine Citation:
PMID:  23203672     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To study the effect of valgus malalignment on knee osteoarthritis (OA) incidence and progression.
METHODS: We measured the mechanical axis from long limb radiographs from the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI) to define limbs with valgus malalignment (mechanical axis of ≥1.1° valgus) and examined the effect of valgus alignment versus neutral alignment (neither varus nor valgus) on OA structural outcomes. Posteroanterior radiographs and knee magnetic resonance (MR) images were obtained at the time of the long limb radiograph and at followup examinations. Lateral progression was defined as an increase in joint space narrowing (on a semiquantitative scale) in knees with OA, and incidence was defined as new lateral narrowing in knees without radiographic OA. We defined lateral cartilage damage and progressive meniscal damage as increases in cartilage or meniscus scores at followup on the Whole-Organ Magnetic Resonance Imaging Score scale (for the MOST) or the Boston Leeds Osteoarthritis Knee Score scale (for the OAI). We used logistic regression with adjustment for age, sex, body mass index, and Kellgren/Lawrence grade, as well as generalized estimating equations, to evaluate the effect of valgus alignment versus neutral alignment on disease outcomes. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs).
RESULTS: We studied 5,053 knees (881 valgus) of subjects in the MOST cohort and 5,953 knees (1,358 valgus) of subjects in the OAI cohort. In both studies, all strata of valgus malalignment, including 1.1° to 3° valgus, were associated with an increased risk of lateral disease progression. In knees without radiographic OA, valgus alignment >3° was associated with incidence (e.g., in the MOST, adjusted OR 2.5 [95% CI 1.0-5.9]). Valgus alignment >3° was also associated with cartilage damage on MR imaging in knees without OA (e.g., in the OAI, adjusted OR 5.9 [95% CI 1.1-30.3]).We found a strong relationship of valgus malalignment with progressive lateral meniscal damage.
CONCLUSION: Valgus malalignment increases the risk of knee OA radiographic progression and incidence as well as the risk of lateral cartilage damage. It may cause these effects, in part, by increasing the risk of meniscal damage.
David T Felson; Jingbo Niu; K Douglas Gross; Martin Englund; Leena Sharma; T Derek V Cooke; Ali Guermazi; Frank W Roemer; Neil Segal; Joyce M Goggins; C Elizabeth Lewis; Charles Eaton; Michael C Nevitt
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  65     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-29     Completed Date:  2013-04-11     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  355-62     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 by the American College of Rheumatology.
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MeSH Terms
Bone Malalignment / complications*,  epidemiology,  radiography
Disease Progression
Health Surveys
Knee Joint / radiography*
Middle Aged
Osteoarthritis, Knee / epidemiology,  etiology*,  radiography
Risk Factors
Grant Support
(N01-AR-2-2258/AR/NIAMS NIH HHS; N01-AR-2-2259/AR/NIAMS NIH HHS; N01-AR-2-2260/AR/NIAMS NIH HHS; N01-AR-2-2261/AR/NIAMS NIH HHS; N01-AR-2-2262/AR/NIAMS NIH HHS; P60 AR047785/AR/NIAMS NIH HHS; P60-AR-47785/AR/NIAMS NIH HHS; R01 AR051568/AR/NIAMS NIH HHS; R01-AR-051568/AR/NIAMS NIH HHS; R01-HD-43500/HD/NICHD NIH HHS; U01 AG018820/AG/NIA NIH HHS; U01-AG-18820/AG/NIA NIH HHS; U01-AG-18832/AG/NIA NIH HHS; U01-AG-18947/AG/NIA NIH HHS; U01-AG-19069/AG/NIA NIH HHS
Comment In:
Arthritis Rheum. 2013 Feb;65(2):310-3   [PMID:  23203607 ]

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