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- DOI: 10.1002/art.37726
- PMID: 23203672
- UKPMCID: 23203672
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Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: Findings from MOST and the osteoarthritis initiative.
Felson, David T; Niu, Jingbo; Gross, K Douglas; Englund, Martin; Sharma, Leena; Cooke, T Derek V; Guermazi, Ali; Roemer, Frank W; Segal, Neil; Goggins, Joyce M; Lewis, C Elizabeth; Eaton, Charles; Nevitt, Michael C
Arthritis and rheumatism. 2013;65(2):365-362.
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Full-text held externally
- DOI: 10.1002/art.37726
- PMID: 23203672
- UKPMCID: 23203672
Abstract
OBJECTIVE: We studied the effect of valgus malalignment on knee osteoarthritis (OA) incidence and progression. METHODS: We measured mechanical axis from long limb radiographs from the MOST Study and the Osteoarthritis Initiative (OAI) to define valgus limbs (>1° valgus) and examined the effect of valgus vs. neutral (neither varus nor valgus) on OA structural outcomes. Posteroanterior x-rays and knee MRIs were obtained in subjects at the time of the long limb x-ray and at follow-up examinations. Lateral progression was defined by an increase in joint space narrowing (on a semiquantitative scale) and incidence as new lateral narrowing in knees without x-ray OA. We defined lateral cartilage damage and progressive meniscal damage when WORMS (MOST) or BLOKS (OAI) scores for cartilage or meniscus increased at follow-up. We used logistic regression with adjustment for age, sex, BMI and Kellgren and Lawrence grade and used GEE to evaluate the effect of valgus vs. neutral alignment on disease outcomes. RESULTS: We studied 5046 knees (881 valgus) from MOST and 5953 knees (1235 valgus) from OAI. 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 above 3° was associated with incidence (for example in MOST, adjOR = 2.7 (95% 1.1, 6.8)). Valgus 3° or more was also associated with cartilage damage on MRI in knees without OA (for example in OAI, adjOR = 5.9 (95% CI, 1.3, 30.3)). We found a strong relation of valgus with progressive lateral meniscal damage. CONCLUSIONS: Valgus malalignment increases the risk of knee OA x-ray progression, incidence and of lateral cartilage damage. It may cause these effects, in part, by increasing the risk of meniscal damage. © 2012 American College of Rheumatology.