Quantitative Assessment of Osteoarthritic Knee Instability: Comparison with Conventional Imaging Modalities
Knee osteoarthritis (OA) is the most common musculoskeletal disorder affecting all populations. One common knee OA symptom is instability; thus its assessment could allow diagnosing and following-up of the disease without using conventional imaging techniques, such as plain radiography or magnetic resonance imaging (MRI). Knee kinematic measurements using accelerometers could provide a low-cost and non-invasive option to quantify knee instability. The aim of this study was to assess the relationships between kinematic data, instability parameters derived from the imaging techniques, goniometer-based measurements, and radiological OA stage. The right knees of 66 females (44–67 years) were examined using MRI, plain radiography, and goniometer-based angle measurement. Kellgren–Lawrence (KL) grade and the joint line convergence angle (JLCA) were determined from the radiographs. Cartilage thickness and OA score (MOAKS) were derived from the MRI. A ratio between lateral and medial cartilage thicknesses was calculated from the average thickness of segmented cartilage over the weight bearing area (MRIratio). Accelerometers attached to thigh and shank were used to record kinematic signals during a one-leg-stand test. Power of the accelerometer signals along the anatomical longitudinal axis (Pacc) was used as a measure of knee instability. Finally, Spearman’s correlations between the acquired parameters and KL grade/MOAKS scores were calculated. Leave-one-out cross-validation and logistic regression were used to discriminate OA subjects (KL ≥ 2). All the instability parameters (Pacc, JLCA and MRIratio), except the goniometer angle, showed significant correlations with KL grading (rho = 0.32–0.64, p < 0.01) and MOAKS composite score (rho = 0.35–0.56, p < 0.01). Both Pacc and JLCA showed higher areas under the ROC curve to discriminate OA (AUC = 0.76 and AUC = 0.78) than MRIratio and goniometer angle (AUC = 0.55 and AUC = 0.56). Our results demonstrate the clinical potential of kinematic knee instability measurements using low-cost accelerometers. Such approach could become a potential new tool in OA diagnostics.
KeywordsOsteoarthritis Knee Instability MRI Radiography Accelerometer Kinematics
The authors would like to thank the patients for their participation in the study. The study was funded by the Finnish Funding Agency for Technology and Innovation (TEKES) and Oulu University Hospital.
Conflicts of Interest
The authors declare that they have no conflict of interest.
- 1.Chu CR, Millis MB, Olson SA. Osteoarthritis: From Palliation to Prevention: AOA Critical Issues. J Bone Joint Surg Am 96:e130. (2014)Google Scholar
- 2.Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage 21:1145–1153. (2013)Google Scholar
- 3.Hiligsmann M, Cooper C, Arden N, Boers M, Branco JC, Luisa Brandi M, Bruyere O, Guillemin F, Hochberg MC, Hunter DJ, Kanis JA, Kvien TK, Laslop A, Pelletier JP, Pinto D, Reiter-Niesert S, Rizzoli R, Rovati LC, Severens JL, Silverman S, Tsouderos Y, Tugwell P, Reginster JY. Health economics in the field of osteoarthritis: an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 43:303–313. (2013)Google Scholar
- 4.Guermazi A, Roemer FW, Burstein D, Hayashi D. Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis. Arthritis Res Ther 13:247. (2011)Google Scholar
- 5.Heijink A, Gomoll AH, Madry H, Drobnic M, Filardo G, Espregueira-Mendes J, Van Dijk CN. Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20:423–435. (2012)Google Scholar
- 6.Blalock D, Miller A, Tilley M, Wang J. Joint instability and osteoarthritis. Clin Med Insights Arthritis Musculoskelet Disord 8:15–23. (2015)Google Scholar
- 7.Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35:1756–1769. (2007)Google Scholar
- 8.Freisinger GM, Schmitt LC, Wanamaker AB, Siston RA, Chaudhari AMW. Tibiofemoral Osteoarthritis and Varus-Valgus Laxity. J Knee Surg 30:440–451. (2017)Google Scholar
- 9.Ornetti P, Maillefert JF, Laroche D, Morisset C, Dougados M, Gossec L. Gait analysis as a quantifiable outcome measure in hip or knee osteoarthritis: a systematic review. Joint Bone Spine 77:421–425. (2010)Google Scholar
- 10.van der Straaten R, De Baets L, Jonkers I, Timmermans A. Mobile assessment of the lower limb kinematics in healthy persons and in persons with degenerative knee disorders: A systematic review. Gait Posture 59:229–241. (2017)Google Scholar
- 11.Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. (1957)Google Scholar
- 12.Hunter DJ, Guermazi A, Lo GH, Grainger AJ, Conaghan PG, Boudreau RM, Roemer FW. Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis Cartilage 19:990–1002. (2011)Google Scholar
- 13.Kleeblad LJ, van der List JP, Pearle AD, Fragomen AT, Rozbruch SR. Predicting the Feasibility of Correcting Mechanical Axis in Large Varus Deformities With Unicompartmental Knee Arthroplasty. J Arthroplasty. (2017)Google Scholar
- 14.Sharma L, Chmiel JS, Almagor O, Felson D, Guermazi A, Roemer F, Lewis CE, Segal N, Torner J, Cooke TD, Hietpas J, Lynch J, Nevitt M. The role of varus and valgus alignment in the initial development of knee cartilage damage by MRI: the MOST study. Ann Rheum Dis 72:235–240. (2013)Google Scholar
- 15.Bastick AN, Belo JN, Runhaar J, Bierma-Zeinstra SM. What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis. Clin Orthop Relat Res 473:2969–2989. (2015)Google Scholar
- 16.Amaratunga HA, Adikari SB, Dassanayake TL, Gamage J, Suraweera HJ. Relationship between the goniometric alignment and articular cartilage damage in knee osteoarthritis. Ceylon Med J 62:167–174. (2017)Google Scholar
- 17.van Trijffel E, van de Pol RJ, Oostendorp RA, Lucas C. Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: a systematic review. J Physiother 56:223–235. (2010)Google Scholar
- 18.Julkunen P, Jurvelin JS, Isaksson H. Contribution of tissue composition and structure to mechanical response of articular cartilage under different loading geometries and strain rates. Biomech Model Mechanobiol 9:237–245. (2010)Google Scholar