The Association of Forefoot Varus Deformity with Patellofemoral Cartilage Damage in Older Adult Cadavers

Abstract

Forefoot alignment may contribute to patellofemoral joint (PFJ) osteoarthritis (OA) via its influence on the closed chain kinematics of the lower limb. The purpose of this cadaveric study was to investigate the relationship between forefoot varus and ipsilateral cartilage damage in the medial and lateral PFJ. Forefoot alignment measurements were obtained from the feet of 25 cadavers (n = 50). Cartilage damage in the medial and lateral PFJ of each knee was scored using the Outerbridge scale. The relative odds of medial and lateral PFJ cartilage damage in limbs with forefoot varus and valgus were determined using logistic regression. The relationship between increasing varus alignment and increasing odds of medial and lateral PFJ cartilage damage was assessed. Of the 51% of limbs with forefoot varus, 91.3% had medial, and 78.3% had lateral PFJ cartilage damage, compared with 54.6% and 68.2% of those with forefoot valgus. The former also had 3.0 times (95% CI 1.2, 7.7) the odds of medial PFJ damage; no association was found with lateral damage (OR 1.4, 95% CI 0.7, 3.0). Feet in the highest tertile of varus alignment had 3.9 times (95% CI 10, 15.3, P = 0.058) the odds of medial PFJ damage as those in the lowest tertile. The results of this study suggest a relationship between forefoot varus and medial PFJ cartilage damage in older adults. As forefoot varus may be modified with foot orthoses, these findings indicate a potential role for orthoses in the treatment of medial PFJ OA. Anat Rec, 300:1032-1038, 2017. © 2016 Wiley Periodicals, Inc.

Incidence and risk factors for patellofemoral dislocation in adults with Charcot‐Marie‐Tooth disease: An observational study

“…Similarly, muscle weakness affecting the quadriceps muscles (Greiwe et al., 2010 ), may facilitate the actions of the external forces acting to displace the patella, particularly weakness of the vastus medialis oblique that normally resists lateral patellar displacement. Additionally, foot deformities, observed in 74% of people with CMT (Laurá et al., 2018 ), may affect lower‐limb biomechanics (Lufler et al., 2017 ), thereby altering the load distribution across the knee joint (Barton et al., 2010 ). This will affect the structural integrity of the knee, which can result in PF instability.…”