Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: A critical analysis of the reliability of gait analysis data

Andrews, Michelle; Noyes, Frank R.; Hewett, Timothy E.; Andriacchi, Thomas P.

doi:10.1002/jor.1100140218

Cited by 228 publications

(190 citation statements)

References 27 publications

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“…The Framingham Study found no association with incident knee OA, despite studying a similar number of incident cases (5). The associations we observed between knee malalignment and risks of OA also fit well with what would be expected from load distributions during gait (20,27,28). Most previous studies have studied medial tibiofemoral compartment OA changes.…”

Section: Discussionsupporting

confidence: 78%

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

McWilliams¹,

Doherty²,

Maciewicz³

et al. 2010

Arthritis Care & Research

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Objective. To determine whether self-reported early adult life malalignment of knees or feet are risk factors for knee or hip osteoarthritis (OA). Methods. Participants in the Genetics of Osteoarthritis and Lifestyle case-control database were sent a questionnaire (n ‫؍‬ 3,022) containing line-drawing instruments for self-reported knee and foot alignment at ages 20 -29 years. Respondents were categorized as having straight, valgus, or varus knee, and straight, toe-in, or toe-out feet. Radiographic criteria were used to define current isolated knee or hip OA, combined knee and hip OA, or non-OA controls. Odds ratios (ORs), adjusted ORs, and 95% confidence intervals (95% CIs) were calculated and logistic regression was performed. Results. The response rate was 72%; 87.5% of responders (n ‫؍‬ 1,901) completed the alignment questions. Increased risk of isolated knee OA occurred with early adult varus (adjusted OR 5.16, 95% CI 2.87-9.41) and valgus knees (adjusted OR 3.16, 95% CI 1.04 -9.64). The positive association between knee OA and toe-in foot was explained by varus knee. There was an increased risk of combined knee/hip OA from varus (adjusted OR 4.52, 95% CI 2.39 -8.53) and valgus knees (adjusted OR 3.07, 95% CI 0.99 -9.54). Varus knee was associated with risk of medial tibiofemoral OA, whereas valgus knee was associated with risk of lateral tibiofemoral and lateral patellofemoral OA. Toe-out foot was associated with reduced medial patellofemoral OA. For knee OA, a multiplicative interaction analysis between occupational risks and varus/valgus yielded an OR int of 3.20 (95% CI 1.08 -9.49). Conclusion. Constitutional alignment of the leg in terms of varus or valgus knee or foot rotation may be a significant factor in determining development and distribution of knee but not hip OA.

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Section: Discussionsupporting

confidence: 78%

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

McWilliams¹,

Doherty²,

Maciewicz³

et al. 2010

Arthritis Care & Research

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show abstract

“…A relationship between decreased foot progression angle and increased varus moment at the knee has been reported. 27,28 In our study, no correlation existed between tibial torsion and alignment. There may still be an association with varus moment, which has not been characterized, but could be critical in risk for OA.…”

Section: Discussioncontrasting

confidence: 58%

Anatomic variations between Japanese and Caucasian populations in the healthy young adult knee joint

Hovinga

Lerner

2009

Journal Orthopaedic Research

112

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Our objective was to characterize variations in mechanical knee alignment, tibial torsion, tibial width, and ACL laxity measurements between Japanese and Caucasian populations in the healthy, young adult knee joint. Seventy young adult subjects participated in this study, including 23 Japanese and 47 Caucasian subjects. Coronal magnetic resonance images of the hip, knee, and ankle were acquired for analysis. Japanese subjects had a significantly higher (p ¼ 0.04) varus alignment (1.64 AE 0.438 standard error) than Caucasians (0.55 AE 0.338), while women exhibited a more valgus alignment (0.16 AE 0.528) than men (0.94 AE 0.428, p ¼ 0.04). Significant differences were found in tibial torsion and ACL laxity (p < 0.01) between ethnicities, with Japanese exhibiting lower tibial torsion (33.4 AE 10.08) and higher ACL laxity (7.5 AE 0.4 mm) measurements compared to Caucasians (38.9 AE 9.58 and 5.7 AE 0.3 mm, respectively). Significant differences between genders were found in hip-knee-ankle alignment (p ¼ 0.04), tibial width (p < 0.0001), and ACL laxity (p < 0.01) measurements. Measurements were reliable between observers and for repeated positioning. Our study provides new insight into anatomical and geometric differences in the knee joint between Japanese and Caucasians, as well as between females and males. Further consideration of these results may improve development of implants to accommodate for these differences, and understanding of characteristics leading to increased prevalence of knee OA in certain populations. The use of magnetic resonance imaging to obtain these measurements also allows soft tissue structure characterization without exposure to ionizing radiation. ß

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“…Coronal alignment of the lower extremity in normal subjects has been described in numerous reports [1,2,5,15,16,20]. The tibiofemoral mechanical axis is slightly varus from 1.2°to 2.9° [1,5,20].…”

Section: Discussionmentioning

confidence: 86%

“…The tibiofemoral mechanical axis is slightly varus from 1.2°to 2.9° [1,5,20]. The coronal mechanical axis passes through a relatively medial part of the knee in normal subjects.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Lateral Ligamentous Laxity Diminishes with Time After TKA in the Varus Knee

Sekiya

Takatoku

Takada

et al. 2008

Clin Orthop Relat Res

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For successful TKA, good soft tissue balance is one of the most important factors; however, it is unknown whether the coronal balance immediately after surgery is maintained with time. We hypothesized, if neutral mechanical alignment was achieved at the time of TKA, some degree of lateral ligamentous laxity could be accepted and the laxity would diminish with time. To confirm this hypothesis, we posed two scientific questions: (1) Does the coronal ligament balance measured immediately after TKA change with time? (2) Does the degree of preoperative varus alignment correlate with the lateral or medial ligamentous laxity observed after TKA? We measured coronal lateral or medial ligamentous laxity in 71 knees with varus deformities immediately after surgery and at 3, 6, and 12 months thereafter. The mean mechanical axis was 15.9°varus preoperatively and 0.4°varus postoperatively. The mean medial ligamentous laxity was relatively constant postoperatively from immediately after surgery to 12 months. However, the mean lateral ligamentous laxity was as much as 8.6°immediately after surgery and decreased to 5.1°at 3 months. The lateral ligamentous laxity immediately after surgery correlated with the preoperative varus mechanical axis. Our data show residual lateral ligamentous laxity observed in preoperative varus deformity may be corrected spontaneously after TKA.

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Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: A critical analysis of the reliability of gait analysis data

Cited by 228 publications

References 27 publications

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

Anatomic variations between Japanese and Caucasian populations in the healthy young adult knee joint

Postoperative Lateral Ligamentous Laxity Diminishes with Time After TKA in the Varus Knee

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