Wear Patterns on Tibial Plateaus From Varus and Valgus Osteoarthritic Knees

Harman, Melinda K.; Markovich, G D; Banks, Scott; Hodge, W. Andrew

doi:10.1097/00003086-199807000-00018

Cited by 51 publications

(63 citation statements)

References 41 publications

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“…alignments demonstrate articular cartilage wear patterns in the central to anterior regions of the medial tibial plateau (12). Furthermore, in conditions resembling the stance phase of a normal gait cycle, a computer model of the weight-bearing surfaces of the total knee found the central portion of the medial tibial plateau and the central/posterior portions of the lateral tibial plateau to be the initial contact points during loading of the knee (13).…”

Section: Discussionmentioning

confidence: 84%

Risk factors for progressive cartilage loss in the knee

Biswal¹,

Hastie²,

Andriacchi³

et al. 2002

Arthritis & Rheumatism

208

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Objective. To evaluate the rate of progression of cartilage loss in the knee joint using magnetic resonance imaging (MRI) and to evaluate potential risk factors for more rapid cartilage loss.Methods. We evaluated baseline and followup MRIs of the knees in 43 patients (minimum time interval of 1 year, mean 1.8 years, range 52-285 weeks). Cartilage loss was graded in the anterior, central, and posterior regions of the medial and lateral knee compartments. Knee joints were also evaluated for other pathology. Data were analyzed using analysis of variance models.Results. Patients who had sustained meniscal tears showed a higher average rate of progression of cartilage loss (22%) than that seen in those who had intact menisci (14.9%) (P < 0.018). Anterior cruciate ligament (ACL) tears had a borderline significant influence (P < 0.06) on the progression of cartilage pathology. Lesions located in the central region of the medial compartment were more likely to progress to more advanced cartilage pathology (progression rate 28%; P < 0.003) than lesions in the anterior (19%; P < 0.564) and posterior (17%; P < 0.957) regions or lesions located in the lateral compartment (average progression rate 15%; P < 0.707). Lesions located in the anterior region of the lateral compartment showed less progression of cartilage degradation (6%; P < 0.001). No specific grade of lesion identified at baseline had a predilection for more rapid cartilage loss (P < 0.93).Conclusion. MRI can detect interval cartilage loss in patients over a short period (<2 years). The presence of meniscal and ACL tears was associated with more rapid cartilage loss. Cartilage lesions located in the central region of the medial compartment showed more rapid progression of cartilage loss than cartilage lesions in the anterior and posterior portions of the medial compartment. The findings in this study suggest that patients entering clinical trials investigating antiarthritis regimens may need to be randomized based on location of the lesion.

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Section: Discussionmentioning

confidence: 84%

Risk factors for progressive cartilage loss in the knee

Biswal¹,

Hastie²,

Andriacchi³

et al. 2002

Arthritis & Rheumatism

208

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“…Loading and cartilage wear within the medial compartment appear to vary depending on factors such as the integrity of the anterior cruciate ligament (18,30,31), meniscal status (32,33), and joint malalignment (18,31). For example, one study found the greatest cartilage wear in the anterior regions in medial knee OA (34), whereas others have shown greater involvement in the posterior regions (18,31).…”

Section: Discussionmentioning

confidence: 99%

“…For example, one study found the greatest cartilage wear in the anterior regions in medial knee OA (34), whereas others have shown greater involvement in the posterior regions (18,31). Subregional vBMD differences between groups might reflect these loading variations given that bone responds to the loads that are placed upon it.…”

Section: Discussionmentioning

confidence: 99%

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Bennell¹,

Creaby²,

Wrigley³

et al. 2008

Arthritis & Rheumatism

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Objective. Knee osteoarthritis (OA) is an organlevel failure of the joint involving pathologic changes in articular cartilage and bone. This cross-sectional study compared apparent volumetric bone mineral density (vBMD) of proximal tibial subchondral trabecular bone in people with and without knee OA, using peripheral quantitative computed tomography (pQCT).Methods. Seventy-five individuals with mild or moderate medial compartment knee OA and 41 asymptomatic controls were recruited. Peripheral QCT was used to measure vBMD of trabecular bone beneath medial and lateral tibiofemoral compartments at levels of 2% and 4% of tibial length, distal to the tibial plateau.Results. There was no significant difference in vBMD beneath the overall medial and lateral compartments between the 3 groups. However, in the affected medial compartment of those with moderate OA, lower vBMD was seen in the 2 posterior subregions compared with controls and those with mild knee OA, while higher vBMD was seen in the anteromedial subregion. Beneath the unaffected or lesser affected lateral compartment, significantly lower vBMD was seen at the 2% level in the anterior and lateral subregions of those with moderate disease. Volumetric BMD ratios showed relatively higher vBMD in the medial compartment compared with the lateral compartment, but these ratios were not influenced by disease status.Conclusion. Subregional vBMD changes were evident beneath the medial and lateral compartments of those with moderate medial knee OA. Of import, the posterior subchondral trabecular regions of the medial tibial plateau have markedly lower vBMD.

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“…For these prostheses to be effective, however, there should be an intact ACL present at the time of arthroplasty. The current literature has variable reports of the presence of the ACL at the time of surgery [10,12,17,20,21,24]. Additionally, because of arthritic degeneration such as joint space narrowing and osteophytic changes at the joint, it may be difficult to assess the ACL preoperatively by physical examination.…”

Section: Discussionmentioning

confidence: 99%

The ACL in the Arthritic Knee: How Often Is It Present and Can Preoperative Tests Predict Its Presence?

Johnson

Howell

Costa

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background TKA with retention of the anterior cruciate ligament (ACL) may improve kinematics and function. However, conflicting reports exist concerning the prevalence of intact ACLs at the time of TKA. Questions/purposes Therefore, we asked: (1) what was the ACL status at TKA; (2) what was the sensitivity and specificity of the Lachman test; (3) did MRI ACL integrity correlate with intraoperative observation; (4) did MRI tibial wear patterns correlate with ACL integrity; and (5) did ACL status depend on age or sex? Methods We evaluated 200 patients for ACL integrity at the time of TKA. All patients underwent a Lachman test under anesthesia. Intraoperatively, the ACL was characterized as intact, frayed, disrupted, or absent. In 100 patients, MRIs were performed, from which the ACL was graded as intact, indeterminate, or disrupted, and the AP location of tibial wear was categorized. Results The ACL was intact in 155 patients (78%). The Lachman test alone had poor diagnostic ability. The MRI predicted a tear, but we observed two ACLs with indeterminate status that were disrupted. All knees with anterior wear on the medial tibial condyle had an intact ACL (n = 45), and all knees with posterior wear on the medial tibial condyle had a disrupted ACL (n = 8).Conclusions Although the Lachman test alone had poor sensitivity, when combined with MRI they together provide a sensitivity of 93.3% and specificity of 99%, which we believe makes these reasonable tests for assessing ACL status in the arthritic knee.

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Wear Patterns on Tibial Plateaus From Varus and Valgus Osteoarthritic Knees

Cited by 51 publications

References 41 publications

Risk factors for progressive cartilage loss in the knee

Risk factors for progressive cartilage loss in the knee

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

The ACL in the Arthritic Knee: How Often Is It Present and Can Preoperative Tests Predict Its Presence?

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