Clinical Rheumatology

, Volume 38, Issue 12, pp 3557–3566 | Cite as

The effect of alignment on knee osteoarthritis initiation and progression differs based on anterior cruciate ligament status: data from the Osteoarthritis Initiative

  • Shawn M RobbinsEmail author
  • Nicolas Raymond
  • François Abram
  • Jean-Pierre Pelletier
  • Johanne Martel-Pelletier
Original Article



Knee alignment and anterior cruciate ligament (ACL) injury are risk factors for knee osteoarthritis (OA). The objective was to examine interactions between knee alignment and ACL status on cartilage volume loss in participants with or at risk of knee OA.


Participants were from the Osteoarthritis Initiative, a longitudinal cohort study. Data were from baseline and 24- and 72-month follow-up visits. Participants with knee OA (progression subcohort) or at risk of knee OA (incidence subcohort) that had partial or full ACL tears (OA-ACL group; n=66) or an intact ACL (OA-only group, n=367) were selected. Femur-tibia angles from radiographs quantified knee alignment. Changes in tibial and femoral cartilage volumes were measured using magnetic resonance imaging. Hierarchical linear models examined if knee alignment, presence of ACL, and their interaction were related to cartilage volume loss after accounting for other variables.


Interactions between alignment and ACL status were significantly related to cartilage volume loss in the lateral plateau (β=−20.19, 95% confidence interval [CI]=−34.65 to −5.73) and lateral condyle (β=−23.64, 95%CI=−43.06 to −4.23). Valgus alignment was related to lateral compartment cartilage loss in the OA-ACL group, but not in the OA-only group. Varus alignment was related to cartilage loss in the medial plateau (β=7.49, 95%CI=0.17 to 14.80) and medial condyle (β=19.70, 95%CI=5.96 to 33.44) in both groups.


The impact of knee alignment on knee OA initiation and progression varies based on ACL status. Initial lateral compartment damage or changes in joint kinematics after ACL rupture might account for these findings.

Key Points

The relationship between knee alignment and lateral compartment cartilage loss depended on the status of the anterior cruciate ligament in participants with knee osteoarthritis or at risk for knee osteoarthritis.

Valgus alignment was related to lateral compartment cartilage loss in participants with a deficient anterior cruciate ligament.

Varus alignment was related to medial compartment cartilage loss regardless of the status of the anterior cruciate ligament.


Anterior cruciate ligament Articular cartilage Knee osteoarthritis Magnetic resonance imaging Valgus Varus 


Funding information

Shawn Robbins is supported by the Arthritis Society (grant number YIS-14-065) and the Fonds de recherche du Québec – Santé (grant number 33107). The OAI is a public-private partnership comprised five contracts (N01-AR-2-2258; N01-AR-2-2259; N01AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health. Funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the Consortium and OAI is managed by the Foundation for the National Institutes of Health. Data provided from the FNIH OA Biomarkers Consortium Project made possible through grants and direct or in-kind contributions by the following: AbbVie; Amgen; Arthritis Foundation; Artialis; Bioiberica; BioVendor; DePuy; Flexion Therapeutics; GSK; IBEX; IDS; Merck Serono; Quidel; Rottapharm | Madaus; Sanofi; Stryker; the Pivotal OAI MRI Analyses (POMA) study, NIH HHSN2682010000 21C; and the Osteoarthritis Research Society International.

Compliance with ethical standards

Conflict of interest statement

Jean-Pierre Pelletier and Johanne Martel-Pelletier are shareholders in ArthroLab Inc. François Abram is an employee of ArthroLab Inc. There are no other conflicts of interest to report.

Ethical standards

Ethics approval for the OAI database was made by the Institutional Review Board of the University of California (approval number 10-00532) and from the clinical sites that participated in the study. Informed consent was obtained from participants during enrollment into the OAI.


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Centre for Interdisciplinary Research in Rehabilitation and Lethbridge-Layton-MacKay Rehabilitation CentreMontrealCanada
  2. 2.School of Physical and Occupational TherapyMcGill UniversityMontrealCanada
  3. 3.Medical Imaging, ArthroLab Inc.MontrealCanada
  4. 4.Osteoarthritis Research UnitUniversity of Montreal Hospital Research Centre (CRCHUM)MontrealCanada

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