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Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Varus alignment is known as one of the major causes of medial compartment osteoarthritis (OA). Medial meniscus extrusion also plays a critical role in the in the development of OA. However, studies on the exact relationship between alignment parameters and medial meniscus extrusion are limited. Therefore, this study aimed to investigate this relationship in patients with knee OA.

Methods

Based on a retrospective analysis of the outpatient magnetic resonance imaging (MRI) database, 190 knees were identified to be examined using weight-bearing, whole-leg radiographs and MRIs within 3 months from the first consultation. Subsequently, various parameters of lower leg alignment were measured, which affected the knee varus in radiographs. Finally, a statistical analysis was performed to assess the relationships between the OA grade, distance of medial meniscus extrusion (MME), and alignment parameters; hip–knee–ankle angle (HKAA), percentage of mechanical axis (% MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). The subjects were divided according to the presence or absence of MME (Group A: MME distance below 3 mm, Group B: MME distance 3 mm and above) to assess the differences in each alignment parameter correlated with MME distance between the groups.

Results

MME distance significantly increased with OA grade progression. HKAA, % MA, MPTA, and JLCA significantly correlated with medial meniscus extrusion distance (r = − 0.21, − 0.23, − 0.16, 0.3, respectively). Multiple regression analysis of each significant alignment combined with age, sex, and body mass index revealed that HKAA, % MA, MPTA, and JLCA were significant independent factors of MME distance (P = 0.008, 0.0026, 0.011, 0.0001, respectively). These significant findings were reinforced in group B. In contrast, the correlation between alignment parameters and medial meniscus extrusion distance was not significant in group A.

Conclusion

Varus alignment factors are related to MME distance especially in extruded meniscus knees, as the OA grade progressed. Therefore, the coexistence of varus alignment and MME can be the risk factors for OA progression. As the low MPTA was an independent alignment factor for generating varus alignment, patients with osteoarthritis of the knee with both, low MPTA and MME could be the appropriate candidates for early intervention by high tibial osteotomy.

Level of evidence

III.

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Abbreviations

OA:

Osteoarthritis

MME:

Medial meniscus extrusion

MRI:

Magnetic resonance imaging

HKAA:

Hip–knee–ankle angle

% MA:

Percentage of mechanical axis

LDFA:

Lateral distal femoral angle

MPTA:

Medial proximal tibial angle

JLCA:

Joint line convergence angle

LDTA:

Lateral distal tibial angle

BMI:

Body mass index

HTO:

High tibial osteotomy;

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Funding

No funding has been received for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Norio Goto, Yukio Akasaki, Hideki Mizu-uchi, Satoshi Hamai & Yasuharu Nakashima

  2. Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Ken Okazaki

  3. Akiyama clinic, 4-17-1 Midorigahama, Kasuya Gun, Shingu Cho, Fukuoka, 811-0119, Japan

    Takenori Akiyama & Shunsuke Nakamura

Authors
  1. Norio Goto
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  2. Ken Okazaki
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  3. Takenori Akiyama
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  4. Yukio Akasaki
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  5. Hideki Mizu-uchi
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  6. Satoshi Hamai
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  7. Shunsuke Nakamura
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  8. Yasuharu Nakashima
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Corresponding author

Correspondence to Yukio Akasaki.

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Conflict of interest

The authors state that there are no conflicts of interest which might have influenced the preparation of this manuscript.

Ethical approval

This study was approved by the institutional review board at Kyushu University (No. 29-428).

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Goto, N., Okazaki, K., Akiyama, T. et al. Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development. Knee Surg Sports Traumatol Arthrosc 27, 2617–2623 (2019). https://doi.org/10.1007/s00167-018-5286-7

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  • DOI: https://doi.org/10.1007/s00167-018-5286-7

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