Different patterns of cartilage wear in medial and lateral gonarthrosis

Weidow, Jonas; Pak, John; Kärrholm, Johan

doi:10.1080/000164702320155347

Cited by 53 publications

(27 citation statements)

References 7 publications

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“…This agrees with the qualitative observations made by Harman et al 1 and Weidow et al 2,3 The CT study of Vande Berg et al 8 also showed that lateral compartment cartilage lesions occur more posteriorly on the tibia than those on the medial compartment. Although the difference in site of the lesion midpoint in medial and lateral OA is small on the tibial side (5 mm on average), it is substantial on the femoral side (15 mm on average).…”

Section: Discussionsupporting

confidence: 82%

Localization of the full‐thickness cartilage lesions in medial and lateral unicompartmental knee osteoarthritis

Gulati

Chau

Beard

et al. 2009

Journal Orthopaedic Research

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This study's aim was to determine the patterns of osteoarthritis (OA) in both unicompartmental medial and lateral OA of the knee. Forty patients with medial and 20 with lateral unicompartmental knee osteoarthritis were studied to determine the location of fullthickness cartilage lesions. Intraoperatively, the distance between margins of the lesion and reference lines were measured. The femoral measurements were transposed onto lateral radiographs to determine the relationship between the lesion site and knee flexion angles. Both tibial and femoral lesions were significantly (p < 0.01) more posterior in lateral OA than medial OA. In medial OA, the lesion center was, on average, at 118 (SD 38) of flexion, whereas in lateral OA, it was at 408 (SD 38). The smallest medial femoral lesions were near full extension and, as they enlarged, they extended posteriorly. The smallest lateral femoral lesions extended from 208 to 608 flexion. As these lesions enlarged, they extended both anteriorly and posteriorly. There was a well-defined relationship between the site of the lesions and their size, suggesting that they develop and progress in a predictable manner. The relationship was different for medial and lateral OA, suggesting that different mechanical factors are important in initiating the different types of OA. The lesions in medial OA occur in extension, perhaps initiated by events occurring at heel strike. The lesions in lateral OA begin at flexion angles above those occurring during the single leg stance phase of the gait cycle, so activities other than gait are likely to induce lateral OA. ß

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Section: Discussionsupporting

confidence: 82%

Localization of the full‐thickness cartilage lesions in medial and lateral unicompartmental knee osteoarthritis

Gulati

Chau

Beard

et al. 2009

Journal Orthopaedic Research

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“…This view is, however, not routinely used in Sweden. It might have added further information to our study and especially in lateral arthrosis, where the most pronounced wear is localized posteriorly (Weidow et al 2002). There are several possible reasons for why the semi-flexed position is superior to full extension in the diagnosis of arthrosis.…”

Section: Discussionmentioning

confidence: 98%

“…The increased scatter observed in lateral arthrosis may reflect the fact that weight-bearing on the most eroded part of the joint is difficult to achieve. In these cases, maximum wear is often located posteriorly on both the tibia and the femur (Harman et al 1998, Weidow et al 2002. Flexion to 20-30 degrees is often not sufficient to reach this part of the joint, resulting in a more pronounced underestimation of the true progression of the disease.…”

Section: Discussionmentioning

confidence: 99%

Standing radiographs underestimate joint widthComparison before and after resection of the joint in 34 total knee arthroplasties

Weidow¹,

Mars²,

Cederlund³

et al. 2004

Acta Orthopaedica Scandinavica

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BackgroundMeasurement or estimation of joint width is routinely used in the preoperative evaluation of gonarthrosis. To our knowledge, the validity and reproducibility of this procedure has not been adequately studied.Patients and methods We measured joint width in 34 knees (medial arthrosis: n = 22, lateral arthrosis: n = 12) on preoperative weight-bearing radiographs and on radiographs of the corresponding part of the joint after knee arthroplasty. The bone/cartilage pieces were placed in anatomical positions and loaded in a jig made of perspex. High-density film was used to obtain maximum resolution.Results In medial and lateral arthrosis, the minimum joint widths were median 0.3 and 0.2 mm smaller on the radiographs of the specimens (p = 0.05, 0.04). In lateral arthrosis the differences were more scattered (95% CI: lateral: 0.1 to -1.2 mm; medial: 0 to -0.5 mm), suggesting less precise determination.Interpretation In medial arthrosis, the degree of underestimation is usually small and acceptable. More pronounced discrepancies could be found in lateral arthrosis, calling for the use of further diagnostic measures.

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“…A more posterior contact of the lateral femoral condyle might also explain posterior cartilage wear in lateral OA. 28 The relative tibiofemoral rotations throughout flexion-extension in OA knees are not completely known. In a previous radiostereometric evaluation, Saari and colleagues 29 studied knee kinematics during active extension and weight bearing.…”

Section: Discussionmentioning

confidence: 99%

Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: Gait analysis of 30 patients and 15 controls

et al. 2006

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The motions and moments in the hip and knee in female patients on the waiting list for knee prosthesis surgery with medial (n ¼ 15) or lateral (n ¼ 15) osteoarthritis (OA) were compared with a control group (n ¼ 15). We hypothesized that not only the kinematics and kinetics of the knee but also of the hip would differ between patients the medial and lateral groups. At midstance, patients with lateral OA showed slightly (28) more maximal (peak) adduction ( p ¼ 0.015) of the hip joint and patients with medial OA had 78 more abduction (p < 0.001) than did controls. In patients with lateral OA, the femur was positioned in about 78 more maximum external rotation (p ¼ 0.001), but femur position did not differ between medial OA and controls ( p ! 0.8). There was a tendency to higher internal hip rotation moment in lateral OA compared to controls ( p ¼ 0.021). The maximum values of the internal knee abduction moments were 52% higher in medial OA ( p ¼ 0.005) and 63% lower in lateral OA ( p < 0.001) compared to controls. Cases with medial OA had 98 more, whereas those with lateral OA had 68 less external tibial rotation than controls (medial vs. lateral OA, p ¼ 0.001). We found an association between presence of lateral OA of the knee and the biomechanics of the hip joint. It remains to be evaluated if the changed biomechanics of the hip joint is a reason for development of lateral OA or an observation that is a result of this disease. ß

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Different patterns of cartilage wear in medial and lateral gonarthrosis

Cited by 53 publications

References 7 publications

Localization of the full‐thickness cartilage lesions in medial and lateral unicompartmental knee osteoarthritis

Localization of the full‐thickness cartilage lesions in medial and lateral unicompartmental knee osteoarthritis

Standing radiographs underestimate joint widthComparison before and after resection of the joint in 34 total knee arthroplasties

Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: Gait analysis of 30 patients and 15 controls

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