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The medial inclination of the proximal tibia is associated with the external knee adduction moment in advanced varus knee osteoarthritis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Whether the inclined articular surface on the medial proximal tibia and the external knee adduction moment (KAM) correlate remains unclear. The hypothesis was that a steeper inclined articular surface correlated with a larger KAM in advanced knee osteoarthritis (OA).

Methods

A total of 44 females (non-OA, 9 knees; early OA, 14 knees; advanced OA, 21 knees; mean age, 58 ± 16 years) were examined. Three-dimensional (3D) assessment was used on biplanar long-leg radiographs and 3D bone models using a 3D to 2D image registration technique. The approximation plane in the proximal tibia was determined using the least-square method. The joint moments were mathematically calculated in a gait analysis, applying a motion capture system and force plates. The main evaluation parameters were the femorotibial angle (FTA), the coronal inclination of the approximation plane in the medial proximal tibia (coronal inclination), and internal knee joint moments. The KAM means the external moments balanced with the internal knee abduction moments.

Results

The advanced OA showed a larger internal abduction moment (p = 0.017) at the loading response than the other groups. The larger FTA and steeper coronal inclination correlated with the larger internal abduction moment (FTA, p < 0.001; coronal inclination, p = 0.003) at the loading response.

Conclusions

As the clinical relevance, the association among the coronal inclination of the medial proximal tibia, lower extremity alignment, and KAM is one of the key factors to help better understand the etiology of knee OA.

Level of evidence

III.

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References

  1. Akai M, Doi T, Fujino K, Iwaya T, Kurosawa H, Nasu T (2005) An outcome measure for Japanese people with knee osteoarthritis. J Rheumatol 32:1524–1532

    PubMed  Google Scholar 

  2. Andriacchi TP, Johnson TS, Hurwitz DE (2005) Musculoskeletal dynamics locomotion, and clinical applications. In: Mow VC, Huiskes R (eds) Basic orthopaedics and mechano-biology, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 90–121

    Google Scholar 

  3. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 16:494–502

    Google Scholar 

  4. Chang AH, Moisio KC, Chmiel JS, Eckstein F, Guermazi A, Prasad PV, Zhang Y, Almagor O, Belisle L, Hayes K, Sharma L (2015) External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis. Osteoarthr Cartil 23:1099–1106

    Article  CAS  Google Scholar 

  5. Foroughi N, Smith R, Vanwanseele B (2009) The association of external knee adduction moment with biomechanical variables in osteoarthritis: a systematic review. Knee 16:303–309

    Article  PubMed  Google Scholar 

  6. Higano Y, Hayami T, Omori G, Koga Y, Endo K, Endo N (2016) The varus alignment and morphologic alterations of proximal tibia affect the onset of medial knee osteoarthritis in rural Japanese women: case control study from the longitudinal evaluation of Matsudai Knee osteoarthritis survey. J Orthop Sci 21:166–171

    Article  PubMed  Google Scholar 

  7. Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019a) Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surg Sports Traumatol Arthrosc 27:1385–1393

    Article  PubMed  Google Scholar 

  8. Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019b) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27:1394–1402

    Article  PubMed  Google Scholar 

  9. Hollister AM, Jatana S, Singh AK, Sullivan WW, Lupichuk AG (1993) The axes of rotation of the knee. Clin Orthop Relat Res 290:259–268

    Article  Google Scholar 

  10. Ishii Y, Noguchi H, Sato J, Ishii H, Todoroki K, Toyabe S (2018) Medial and lateral laxity in knees with advanced medial osteoarthritis. Osteoarthr Cartil 26:666–670

    Article  CAS  Google Scholar 

  11. Kobayashi K, Sakamoto M, Tanabe Y, Ariumi A, Sato T, Omori G, Omori G, Koga Y (2009) Automated image registration for assessing three-dimensional alignment of entire lower extremity and implant position using bi-plane radiography. J Biomech 42:2818–2822

    Article  PubMed  Google Scholar 

  12. Koga Y (2008) Osteoarthritic of the knee: epidemiology, biomechanics, and conservative treatment [In Japansese] Chapter 2:41–65

  13. Maly MR, Acker SM, Totterman S, Tamez-Peña J, Stratford PW, Callaghan JP, Adachi JD, Beattie KA (2015) Knee adduction moment relates to medial femoral and tibial cartilage morphology in clinical knee osteoarthritis. J Biomech 48:3495–3501

    Article  PubMed  Google Scholar 

  14. Marriott KA, Birmingham TB, Leitch KM, Pinto R, Giffin JR (2019) Strong independent associations between gait biomechanics and pain in patients with knee osteoarthritis. J Biomech 94:123–129

    Article  PubMed  Google Scholar 

  15. Matsumoto T, Hashimura M, Takayama K, Ishida K, Kawakami Y, Matsuzaki T, Nakano N, Matsushita T, Kuroda R, Kurosaka M (2015) A radiographic analysis of alignment of the lower extremities–initiation and progression of varus-type knee osteoarthritis. Osteoarthr Cartil 23:217–223

    Article  CAS  Google Scholar 

  16. Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S (2002) Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis 61:617–622

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Mochizuki T, Tanifuji O, Koga Y, Sato T, Kobayashi K, Nishino K, Watanabe S, Ariumi A, Fujii T, Yamagiwa H, Omori G, Endo N (2017) Sex differences in femoral deformity determined using three-dimensional assessment for osteoarthritic knees. Knee Surg Sports Traumatol Arthrosc 25:468–476

    Article  PubMed  Google Scholar 

  18. Mochizuki T, Tanifuji O, Koga Y, Hata R, Mori T, Nishino K, Sato T, Kobayashi K, Omori G, Sakamoto M, Tanabe Y, Endo N (2017) External torsion in a proximal tibia and internal torsion in a distal tibia occur independently in varus osteoarthritic knees compared to healthy knees. J Orthop Sci 22(3):501–505

    Article  PubMed  Google Scholar 

  19. Mochizuki T, Tanifuji O, Koga Y, Sato T, Kobayashi K, Watanabe S, Fujii T, Yamagiwa H, Katsumi R, Koga H, Omori G, Endo N (2018) Correlation between posterior tibial slope and sagittal alignment under weight-bearing conditions in osteoarthritic knees. PLoS ONE 13:e0202488

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mochizuki T, Koga Y, Tanifuji O, Sato T, Watanabe S, Koga H, Kobayashi K, Omori G, Endo N (2019) Effect on inclined medial proximal tibial articulation for varus alignment in advanced knee osteoarthritis. J Exp Orthop 6:14

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mochizuki T, Koga Y, Mori T, Nishino K, Kobayashi K, Tanifuji O, Sato T, Katsumi R, Koga H, Omori G, Tanabe Y (2019) Articular surface of the medial proximal tibia is aligned parallel to the ground in three-dimensional space under weight-bearing conditions in healthy and varus osteoarthritic knees. Knee Surg Sport Traumatol Arthrosc. https://doi.org/10.1016/j.arth.2018.02.009

    Article  Google Scholar 

  22. Nie Y, Wang H, Xu B, Zhou Z, Shen B, Pei F (2019) The relationship between knee adduction moment and knee osteoarthritis symptoms according to static alignment and pelvic drop. Biomed Res Int. https://doi.org/10.1155/2019/7603249

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nishino K, Omori G, Koga Y, Kobayashi K, Sakamoto M, Tanabe Y, Tanaka M, Arakawa M (2015) Three-dimensional dynamic analysis of knee joint during gait in medial knee osteoarthritis using loading axis of knee. Gait Posture 42:127–132

    Article  PubMed  Google Scholar 

  24. Nishino K, Yamamoto N, Tanaka M, Ohishi T, Tanaka Y, Okamura N, Sekine H, Arakawa M, Omori G (2020) Effect of throwing kinematics and kinetics on different ranges of long toss in youth baseball players. Multidiscip Digit Publ Inst Proc 49:118. https://doi.org/10.3390/proceedings2020049118

    Article  Google Scholar 

  25. Sato T, Koga Y, Omori G (2004) Three-dimensional lower extremity alignment assessment system: application to evaluation of component position after total knee arthroplasty. J Arthroplasty 19:620–628

    Article  PubMed  Google Scholar 

  26. Takeuchi H (2019) Gait- and postural-alignment-related prognostic factors for hip and knee osteoarthritis: toward the prevention of osteoarthritis progression. Phys Ther Res 22:31–37

    Article  Google Scholar 

  27. Telfer S, Lange MJ, Sudduth ASM (2017) Factors influencing knee adduction moment measurement: a systematic review and meta-regression analysis. Gait Posture 58:333–339

    Article  PubMed  Google Scholar 

  28. Thorlund JB, Holsgaard-Larsen A, Creaby MW, Jørgensen GM, Nissen N, Englund M, Lohmander LS (2016) Changes in knee joint load indices from before to 12 months after arthroscopic partial meniscectomy: a prospective cohort study. Osteoarthr Cartil 24:1153–1159

    Article  CAS  Google Scholar 

  29. Tokuda K, Anan M, Takahashi M, Sawada T, Tanimoto K, Kito N, Shinkoda K (2018) Biomechanical mechanism of lateral trunk lean gait for knee osteoarthritis patients. J Biomech 66:10–17

    Article  PubMed  Google Scholar 

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Funding

This study received KAKENHI from grants-in-aid for scientific research in Japan society for the promotion of science.

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Authors and Affiliations

  1. Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan

    Tomoharu Mochizuki, Osamu Tanifuji, Hiroshi Koga & Hiroyuki Kawashima

  2. Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan

    Go Omori

  3. Niigata Institute for Health and Sports Medicine, Niigata, Japan

    Katsutoshi Nishino & Masaei Tanaka

  4. Graduate School of Science and Technology, Niigata University, Niigata, Japan

    Takahiro Mori

  5. Department of Orthopaedic Surgery, Nioji Onsen Hospital, Niigata, Japan

    Yoshio Koga

Authors
  1. Tomoharu Mochizuki
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  2. Go Omori
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  3. Katsutoshi Nishino
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  4. Masaei Tanaka
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  5. Osamu Tanifuji
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  6. Hiroshi Koga
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  7. Takahiro Mori
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  8. Yoshio Koga
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  9. Hiroyuki Kawashima
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Correspondence to Tomoharu Mochizuki.

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Mochizuki, T., Omori, G., Nishino, K. et al. The medial inclination of the proximal tibia is associated with the external knee adduction moment in advanced varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 30, 574–583 (2022). https://doi.org/10.1007/s00167-020-06323-8

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  • DOI: https://doi.org/10.1007/s00167-020-06323-8

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