Estimation of individual thigh muscle volumes from a single-slice muscle cross-sectional area and muscle thickness using magnetic resonance imaging in patients with knee osteoarthritis Knee alignment does not predict incident osteoarthritis: the Framingham osteoarthritis study. Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis. Associations between gait and clinical parameters in patients with severe knee osteoarthritis: a multiple correspondence analysis. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design Are unilateral and bilateral knee osteoarthritis patients unique subsets of knee osteoarthritis? A biomechanical perspective. Cross-cultural adaptation and validation of the Oxford 12-item knee score in Japanese Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis. Modified walking shoes for knee osteoarthritis: Mechanisms for reductions in the knee adduction moment. Resistance training for medial compartment knee osteoarthritis and malalignment. Nonrandom evolution of end-stage osteoarthritis of the lower limbs. Effect of alignment of the medial tibial plateau and x-ray beam on apparent progression of osteoarthritis in the standing anteroposterior knee radiograph. Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis Increased Risk of Osteoarthritis After Anterior Cruciate Ligament Reconstruction The relationship between prospectively assessed body weight and physical activity and prevalence of radiological knee osteoarthritis in postmenopausal women. Foot kinematics in people with medial compartment knee osteoarthritis.
Purpose : This study aim ed to identify the best single-slice anatomical muscle cross-sectional area ( CSA ) and muscle thickness ( MT ) on magnetic resonance imaging ( MRI ) to estimate the overall individual muscle volumes ( MVs ) of knee extensors and flexors in patients with knee osteoarthritis ( KOA ) . Methods : Twelve patients ( 24 legs ; 4 men and 8 women ) with KOA underwent a 1.5-Tesla axial MRI scan in the femoral region of interest ( ROI ) , between the lesser trochanter and rectus femoris tendon . Individual MVs were calculated by numerical integration based on individual CSAs analyzed at the ROI . The best slice was determined as follows : coefficient of determination ( R 2 ) between MVs measured and those estimated from the femoral length ( FL ) × CSAs or FL × MTs measured at each 10 % interval level of the ROI . These estimation equations were applied for a cross-validation group ( 24 KOA patients : 12 men and 12 women ) . Results : Estimated individual MVs of knee extensors and flexors , based on the CSAs at the distal 10 % level , significantly correlated with each of the measured individual MVs ( R 2 : 0.79–0.96 , p < 0.05 for all ) . Similarly , estimated individual knee extensor MVs , based on MTs at the mid-slice , significantly correlated with each of the measured individual MVs ( R 2 : 0.77–0.84 , p < 0.05 for all ) . The application of the developed regression equation to the cross-validation group did not exhibit any systematic bias . Conclusion : These simple methods could be applied in prospect i ve research with a larger number of patients with KOA OBJECTIVE To examine the relationship of knee malalignment to the occurrence of  knee osteoarthritis ( OA ) among subjects without radiographic OA at baseline to determine whether malalignment is a risk factor for incident disease or simply a marker of increasing disease severity . METHODS We selected 110 incident tibiofemoral ( TF ) OA case knees ( 76 subjects ) and 356 r and om control knees ( 178 subjects ) from among participants in the Framingham Osteoarthritis Study . Case knees did not have OA at baseline ( 1992 - 1994 examination ) but had developed OA ( Kellgren/Lawrence grade > or=2 ) at followup ( 2002 - 2005 examination ) ( mean of 8.75 years between examinations ) . Control knees did not have OA at baseline . St and ardized digital radiographs of the fully extended knee with weight-bearing were read using a st and ard protocol and eFilm viewing software . We measured the anatomic axis , the condylar angle , the tibial plateau angle , and the condylar tibial plateau angle . The interobserver intraclass correlation coefficient ( ICC ) ranged from 0.93 to 0.96 and the intraobserver ICC from 0.94 to 0.97 . In a knee-specific analysis , we examined the relationship of each alignment measurement to the risk of TF OA using generalized estimating equations , adjusting for age , sex , and body mass index ( BMI ) . We used the same approach to assess the association between each alignment measurement and the risk of medial TF OA . RESULTS Subjects in the case population were older and had a higher BMI than the controls . The alignment values were normally distributed and were not different between the cases and the controls . After adjustment for age , sex and BMI , there was no significant increase in incident OA in the highest quartile compared with the lowest quartile category for any of the alignment measures ( P for trend for anatomic axis and condylar tibial plateau angle was 0.83 and 0.80 , respectively ) . Similar results were also observed for medial compartment OA . CONCLUSION We found that baseline knee alignment is not associated with either incident radiographic TF OA or medial TF OA . These results suggest that malalignment is not a risk factor for OA , but rather is a marker of disease severity and /or its progression STUDY DESIGN Prospect i ve cohort study . OBJECTIVES To characterize knee cartilage change in individuals with knee osteoarthritis ( KOA ) who have completed a therapeutic exercise program .  BACKGROUND While therapeutic exercise is frequently used successfully to improve pain and function in individuals with KOA , no studies have reported the volume of cartilage change or individual factors that may impact volume of cartilage change in those completing an exercise program  for KOA . METHODS Thirteen individuals with KOA underwent  magnetic resonance imaging to quantify cartilage volume change in the weight-bearing regions of the medial and lateral femoral condyles and the entire surface of the tibial plateaus from baseline to 1-year follow-up . Body structure and function measures were taken for body mass index , knee axis alignment , knee motion , and knee strength . Activity limitations and activity levels were also measured prior to the therapeutic exercise program , using the Western Ontario and McMaster Universities Osteoarthritis Index and the Physical Activity Scale for the Elderly . At 6 months from baseline , follow-up clinical measurements of knee strength and motion were performed . At 1 year from baseline , imaging of the knee cartilage and knee alignment were performed , and participants completed the Western Ontario and McMaster Universities Osteoarthritis Index and Physical Activity Scale for the Elderly . RESULTS The central region of the medial femoral condyle ( cMF ) had a median volume of cartilage loss of 3.8 % . The other 3 knee tibiofemoral articular surfaces had minimal median cartilage volume change . Individuals were dichotomized into progressors ( n = 6 ) and nonprogressors ( n = 7 ) , based on the st and ard error of measurement of cartilage volume change for the cMF . Progressors were younger , had a larger body mass index , had a higher Kellgren-Lawrence grade in the medial compartment of the knee , and had a greater increase in knee varus alignment from baseline to 1-year follow-up . The progressors also had frontal plane hip and knee kinetics during baseline gait analysis that potentially increased medial knee joint loading . CONCLUSION The loss of cMF cartilage volume was highly variable and the median loss of cartilage was within the range previously reported . Seven of the 13 individuals did not have cMF cartilage volume loss greater than the st and ard error of measurement . Change in cartilage volume of the cMF may be influenced to a greater extent by personal factors than by completion of a therapeutic exercise program . Additional research is needed to decipher the interactions among therapeutic exercise and personal characteristics that impact knee cartilage loss BACKGROUND Given the complexity of the gait of patients with knee osteoarthritis , a multiple correspondence analysis may be helpful to optimise the extraction of relevant gait and clinical information . Therefore , the aims of this study are to identify the main associations with clinical and gait biomechanical parameters and to evaluate whether there are more specific knee osteoarthritis groups with different gait profiles . METHODS Ninety patients with severe knee osteoarthritis and twenty-six healthy individuals participated in this study .  Pain and function were assessed with the WOMAC Index  ;  knee joint deformity was assessed by the hip-knee-ankle angle on full-limb radiography ; and full body gait analysis was performed with a motion analysis system and force plates . FINDINGS Using multiple correspondence analysis , two categories of gait parameters that best explain the gait variance of patients with knee osteoarthritis were highlighted . The forward displacement category is composed of the parameters speed , stride length , hip flexion and knee flexion . The frontal category is composed of the parameters thorax obliquity and knee adductor moments . Moreover , based on these parameters , four distinct gait profiles were identified : two gait profiles were associated with knee varus deformities , increased thorax obliquity and different forward displacements , while two gait profiles were associated with valgus deformities and different forward displacements . INTERPRETATION These gait parameters can be used to simplify the characterisation of the gait of the knee osteoarthritis population . Patients in varus profiles increase thorax obliquity on the stance limb and may reduce forward displacement . Patients in valgus profiles , however , only reduce forward displacement CONTEXT Knee osteoarthritis ( OA ) is a leading cause of disability in older persons . Few risk factors for disease progression or functional decline have been identified . Hip-knee-ankle alignment influences load distribution at the knee ; varus and valgus alignment increase medial and lateral load , respectively . OBJECTIVE To test the hypotheses that ( 1 ) varus alignment increases risk of medial knee OA progression during the subsequent 18 months , ( 2 ) valgus alignment increases risk of subsequent lateral knee OA progression , ( 3 ) greater severity of malalignment is associated with greater subsequent loss of joint space , and ( 4 ) greater burden of malalignment is associated with greater subsequent decline in physical function . DESIGN AND SETTING Prospect i ve longitudinal cohort study conducted March 1997 to March 2000 at an academic medical center in Chicago , Ill. PARTICIPANTS A total of 237 persons recruited from the community with primary knee OA , defined by presence of definite tibiofemoral osteophytes and at least some difficulty with knee-requiring activity ; 230 ( 97 % ) completed the study . MAIN OUTCOME MEASURES Progression of OA , defined as a 1- grade increase in severity of joint space narrowing on semiflexed , fluoroscopically confirmed knee radiographs ; change in narrowest joint space width ; and change in physical function between baseline and 18 months , compared by knee alignment at baseline . RESULTS Varus alignment at baseline was associated with a 4-fold increase in the odds of medial progression , adjusting for age , sex , and body mass index ( adjusted odds ratio [ OR ] , 4.09 ; 95 % confidence interval [ CI ] , 2.20 - 7.62 ) . Valgus alignment at baseline was associated with a nearly 5-fold increase in the odds of lateral progression ( adjusted OR , 4.89 ; 95 % CI , 2.13 - 11.20 ) . Severity of varus correlated with greater medial joint space loss during the subsequent 18 months ( R = 0.52 ; 95 % CI , 0.40 - 0.62 in dominant knees ) , and severity of valgus correlated with greater subsequent lateral joint space loss ( R = 0.35 ; 95 % CI , 0.21 - 0.47 in dominant knees ) . Having alignment of more than 5 degrees ( in either direction ) in both knees at baseline was associated with significantly greater functional deterioration during the 18 months than having alignment of 5 degrees or less in both knees , after adjusting for age , sex , body mass index , and pain . CONCLUSION This is , to our knowledge , the first demonstration that in primary knee OA varus alignment increases risk of medial OA progression , that valgus alignment increases risk of lateral OA progression , that burden of malalignment predicts decline in physical function , and that these effects can be detected after as little as 18 months of observation Introduction Previous radiostereometric studies have revealed abnormal anterior-posterior translation of the femur in patients operated with AMK ( DePuy , Johnson and Johnson , Leeds , UK ) total knee arthroplasty ( TKA ) . Based on these observations , we hypothesized that patients with TKA have an abnormal gait pattern , and that there are differences in kinematics depending on the design of the tibial joint area . Method We used a gait analysis system to evaluate the influence of joint area design on the kinematics of the hip and knee during level walking .  39 TKA patients ( 42 knees ) and 18 healthy age-matched controls were studied . Patients with 5 ° varus/valgus alignment or less were r and omized to receive either a relatively flat or a concave tibial insert with retention of the posterior cruciate ligament .  Patients who had more than 5 ° varus-valgus alignment and /or extension defect of 10 ° or more were r and omized to receive the concave or a posterior-stabilized tibial component with resection of the posterior cruciate ligament . Results Patients with TKA tended to have less hip and knee extension and decreased knee and hip extension moment than controls . They also tended to walk more slowly . TKA altered the gait pattern , but choice of implant design had little influence . Interpretation In patients with a similar degree of degenerative joint disease and within the limits of the constraints offered by the prostheses under study , the choice of joint area constraint has little influence on the gait pattern OBJECTIVE To compare the gait of adults with unilateral and bilateral symptomatic and radiographic knee osteoarthritis ( OA ) to determine whether these subgroups can be treated similarly in the clinic and when recruiting for r and omized clinical trials , and to use these data to generate future hypotheses regarding gait in these subsets of knee OA patients . METHODS Cross-sectional investigation of patients with unilateral and bilateral knee OA on gait mechanics using 136 older adults ( age ≥55 yrs ; 27 kg m(-2 ) ≥ BMI ≤ 41 kg m(-2 ) ; 82 % female ) with radiographic knee OA . Comparisons were made between the most affected side of the bilateral group ( Bi ) and the affected side of the unilateral group ( Uni ) , and between symmetry indices of each group . RESULTS There were no significant differences in any temporal , kinematic , or kinetic measures between the Uni and Bi cohorts . Comparison of symmetry indices between groups also revealed no significant differences . CONCLUSION The similarity in lower extremity mechanics between unilateral and bilateral knee OA patients is sufficiently robust to consider both subsets as a single cohort . We hypothesize that biomechanical adaptations to knee OA are at least partially systemic in origin and not based solely on the physiological characteristics of an affected knee joint Introduction With the high incidence of knee osteoarthritis ( OA ) in Japan , there is a strong need not only for surgical therapies , but also for vali date d outcome measures . For this study , we completed cross-cultural adaptation , testing and validation of the Oxford knee score ( OKS ) for prospect i ve use in national and international clinical studies involving Japanese patients . Material s and methods The Japanese version of the OKS was developed according to the st and ard cross-cultural adaptation guidelines . For validation , the OKS was tested on 54 patients diagnosed with OA , osteonecrosis , ligament or meniscus injury . Reliability was tested using the intraclass correlation coefficient ( ICC ) . Internal consistency or homogeneity was assessed using Cronbach ’s alpha . The correlation between the Japanese OKS , WOMAC and SF-36 question naires was used to assess construct validity . Results No major difficulties were encountered with the translation and pre-testing stages . For reliability and validity , the Japanese OKS was completed without any missed responses by 53 ( 98.15 % ) and 52 ( 96.30 % ) patients at the first and second distribution , respectively . The total OKS showed good reliability with an ICC of 0.85 . Internal consistency was strong ( Cronbach ’s alpha = 0.90 ) . Strong construct validity ( ICC values of 0.51–0.84 ) was obtained against the WOMAC and SF-36 ( physical functioning , role-physical , bodily pain , and social functioning subscales ) scores . Notable “ ceiling ” effects of the OKS were reported for 11 of the 12 question naire items . Conclusion The Japanese OKS has proven to be a reliable and valid instrument for the self- assessment of knee pain and function in Japanese speaking patients with knee OA and other knee complaints OBJECTIVE To determine the effects of lateral wedged insoles on knee kinetics and kinematics during walking , according to radiographic severity of medial compartment knee osteoarthritis ( OA ) . DESIGN A prospect i ve case control study of patients with medial compartment OA of the knee . SETTING Gait analysis laboratory in a university hospital . PARTICIPANTS Forty-six medial compartment knees with OA of 23 patients with bilateral disease and 38 knees of 19 age-matched healthy subjects as controls . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES We measured the peak external adduction moment at the knee during the stance phase of gait and the first acceleration peak after heel strike at the lateral side of the femoral condyles .  Kellgren and Lawrence grading system was used for radiographic assessment of OA severity . RESULTS The mean value of peak external adduction moment of the knee was higher in OA knees than the control . Application of lateral wedged insoles significantly reduced the peak external adduction moment in Kellgren-Lawrence grade s I and II knee OA patients . The first acceleration peak value after heel strike in these patients was relatively high compared with the control . Application of lateral wedged insoles significantly reduced the first acceleration peak in Kellgren-Lawrence grade s I and II knee OA patients . CONCLUSIONS The kinetic and kinematic effects of wearing of lateral wedged insoles were significant in Kellgren-Lawrence grade s I and II knee OA . The results support the recommendation of use of lateral wedged insoles for patients with early and mild knee OA The objective of this study was to examine mechanisms underpinning the reduction in knee adduction moment ( KAM ) and changes in frontal plane knee-ground reaction force ( GRF ) lever arm with a modified shoe that incorporates both a variable-stiffness sole and lateral wedging .  Thirty individuals with symptomatic knee osteoarthritis ( OA ) and 30 overweight asymptomatic individuals underwent gait analyses wearing modified and st and ard shoes . In both groups , there was a decrease in the lever arm ( p<0.001 ) , and a lateral shift in the center of pressure ( COP ) offset ( p ≤ 0.001 ) . There was no change in frontal plane or medial-lateral GRF magnitudes , lateral trunk lean or stance duration in either group . There was no significant change in the frontal plane hip-knee-ankle angle in the OA group but a significant decrease in the overweight group ( p=0.003 ) . In both groups , changes in lever arm and frontal plane GRF magnitude predicted change in peak KAM ( p<0.01 ) , but only change in lever arm predicted change in KAM impulse ( p<0.001 ) . In the OA group , changes in COP offset and medial-lateral GRF magnitude predicted change in lever arm ( p<0.05 ) , whereas changes in trunk lean and hip-knee-ankle angle predicted change in lever arm in the overweight group ( p=0.01 ) . In conclusion , the change in lever arm contributed the most to explaining change in KAM parameters with modified shoes . The change in the lever arm was driven by changes evident at the foot in the OA participants ( COP and medial-lateral GRF ) , and by more proximal changes ( hip-knee-ankle angle and trunk lean ) in the overweight group PURPOSE S 1 ) To evaluate the effects of a 12-wk high-intensity knee extensor and flexor resistance training program on strength , pain , and adherence in patients with advanced knee osteoarthritis and varus malalignment and 2 ) to generate pilot data for change in dynamic knee joint load , patent-reported outcomes , and self-efficacy after training . METHODS Fourteen patients ( 48.35 + /- 6.51 yr ) with radiographically confirmed medial compartment knee osteoarthritis and varus malalignment of the lower limb were recruited from a surgical waiting list for high tibial osteotomy . Participants completed a high-intensity isokinetic resistance training program three times per week for 12 wk . Knee extensor and flexor strength  were assessed every third week , whereas  pain and adherence  were recorded at every training session . The external knee adduction moment during the gait , the 6-min-walk test , the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and the Arthritis Self-Efficacy Scale ( ASES ) were also evaluated before and after training . RESULTS Significant improvements in knee extensor and flexor strength were observed without increases in pain during or after training . Adherence to the high-intensity program was high . No significant changes were observed for dynamic knee joint load or the KOOS . There was a significant increase in the function subscale of the ASES only . CONCLUSIONS These findings suggest that patients with advanced knee osteoarthritis and malalignment can experience substantial gains in strength after a high-intensity resistance training program without concomitant increases in pain , adverse events , or compromised adherence . These findings provide support for future clinical trials with longer-term outcomes OBJECTIVE Patients with unilateral hip or knee replacements for end-stage osteoarthritis ( OA ) are at high risk for future progression of OA in other joints of the lower extremities , often requiring additional joint replacements . Although the risks of future surgery in the contralateral cognate joints ( i.e. , contralateral hip replacement after an initial hip replacement ) have been evaluated , the evolution of end-stage hip OA to OA involving the knee joints , and vice versa ( i.e. , noncognate progression ) has not been investigated . Because characterization of OA progression in noncognate joints may shed light on the pathogenesis of multijoint OA , we investigated the pattern of evolution of end-stage lower extremity OA in a large , clinical cohort . METHODS Total joint replacement ( TJR ) was selected as a marker of end-stage OA , and a data base comprising all lower extremity TJRs performed at a large referral center between 1981 and 2001 was accessed . Of the 5,894 patients identified , 486 patients with idiopathic OA who underwent hip replacement and 414 who underwent initial knee replacement  were analyzed to determine the relative likelihood of subsequent TJRs .  Patients with the systemic inflammatory arthropathy , rheumatoid arthritis ( RA ) , were evaluated as a control population because RA progression is not considered to be a primarily mechanically mediated process . RESULTS The contralateral cognate joint was the most common second joint to undergo replacement in both the OA and the RA groups . However , in OA patients for whom the second TJR was in a noncognate joint , that joint was > 2-fold more likely to be on the contralateral limb than on the ipsilateral limb ( hip to knee P < 0.001 ; knee to hip P = 0.013 ) . In contrast , among the RA cohort , the evolution was r and om and no laterality for noncognate TJR was observed at either the hip or the knee ( P = 0.782 ) . CONCLUSION This characterization of end-stage lower extremity OA demonstrates that the disease evolves nonr and omly ; after 1 joint is replaced , the contralateral limb is significantly more likely to show progression of OA than is the ipsilateral limb . Thus , OA in 1 weight-bearing joint appears to influence the evolution of OA in other joints . The absence of such laterality in RA suggests that OA progression may be mediated by extrinsic factors such as altered joint loading OBJECTIVE Previous studies of knee osteoarthritis ( OA ) have yielded variable estimates of the rate of joint space narrowing ( JSN ) in the st and ing anteroposterior ( AP ) radiograph , due largely to longitudinal changes in the alignment of the medial tibial plateau ( MTP ) and x-ray beam . To characterize this bias , we examined serial radiographs  of subjects with knee OA in population -based and clinical OA cohorts from 3 locations in the United States and the United Kingdom . METHODS Radiographic features of knee OA ( e.g. ,  osteophytosis , JSN ) and MTP alignment in 428 OA knees were evaluated by consensus of 2 readers . Alignment was considered satisfactory if the anterior and posterior margins of the MTP were superimposed within 1 mm . Readers were blinded to subject identity , and films were read in r and om order . The minimum medial joint space width was also measured manually ( st and ard error of repeated measurements 0.20 mm ) in serial knee images . RESULTS Only 14 % of serial radiographs exhibited alignment of the MTP in both images . In OA knees with satisfactory alignment in both images , the mean rate of JSN over 2 - 3 years ( 0.26 mm/year ) was significantly larger ( P = 0.004 ) than that in OA knees with misalignment in 1 or both radiographs and was 86 % more rapid than the mean JSN in all OA knees . Moreover , the within-group st and ard deviation of JSN was significantly smaller among knees with reproduced alignment of the MTP than in knees in which misalignment occurred in 1 or both images ( P = 0.006 ) . CONCLUSION Poor st and ardization of knee positioning in serial st and ing AP radiographs in previous studies of OA progression has obscured the rate and variability of articular cartilage loss in subjects with knee OA . True JSN ( i.e. , JSN that is not attributable to longitudinal changes in the alignment of the MTP with the x-ray beam in serial radiographic examinations ) may occur more rapidly , and with less between-subject variability , than that previously thought to be characteristic of knee OA Objective Mechanical factors , in particular increased medial knee joint load , are believed to be important in the structural progression of knee osteoarthritis . This study evaluated the relationship of medial knee load during walking to indices of structural disease progression , measured on MRI , in people with medial knee osteoarthritis . Methods A longitudinal cohort design utilising a subset of participants ( n=144 , 72 % ) enrolled in a r and omised controlled trial of lateral wedge insoles was employed .  Medial knee load parameters including the peak knee adduction moment ( KAM ) and the KAM impulse  were measured at baseline using three-dimensional gait analysis during walking . MRI at baseline and at 12 months was used to assess structural indices . Multiple regression with adjustment for covariates assessed the relationship between medial knee load parameters and the annual change in medial tibial cartilage volume . Binary logistic regression was used for the dichotomous variables of progression of medial tibiofemoral cartilage defects and bone marrow lesions ( BML ) . Results A higher KAM impulse , but not peak KAM , at baseline was independently associated with greater loss of medial tibial cartilage volume over 12 months ( β=29.9 , 95 % CI 6.3 to 53.5 , p=0.01 ) . No significant relationships were seen between medial knee load parameters and the progression of medial tibiofemoral cartilage defects or BML . Conclusion This study suggests knee loading , in particular the KAM impulse , may be a risk factor for loss of medial tibial cartilage volume . As knee load is modifiable , load-modifying treatments may potentially slow disease progression Background : The reported prevalence of  radiological osteoarthritis ( OA ) after anterior cruciate ligament ( ACL ) reconstruction  varies from 10 % to 90 % . Purpose /Hypothesis : To report the prevalence of OA after ACL reconstruction and to compare the OA prevalence between quadrupled semitendinosus tendon ( ST ) and bone – patellar tendon – bone ( BPTB ) grafts . The hypothesis was that there would be no difference in OA prevalence between the graft types . The secondary aim was to study whether patient characteristics and additional injuries were associated with long-term outcomes . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Radiological examination results , Tegner activity levels , and Knee injury and Osteoarthritis Outcome Score ( KOOS ) values were determined in 135 ( 82 % ) of 164 patients at a mean of 14 years after ACL reconstruction r and omized to an ST or a BPTB graft .  Osteoarthritis was defined according to a consensus by at least 2 of 3 radiologists of Kellgren-Lawrence grade ≥2 . Using regression analysis , graft type , sex , age , overweight , time between injury and reconstruction , additional meniscus injury , and a number of other variables were assessed as risk factors for OA 14 years after ACL reconstruction . Results : Osteoarthritis of the medial compartment was most frequent , with 57 % of OA cases in the ACL-reconstructed knee and 18 % of OA cases in the contralateral knee ( P < .001 ) . There was no difference between the graft types : 49 % of OA of the medial compartment for BPTB grafts and 65 % for ST grafts ( P = .073 ) . The KOOS results were lower for patients with OA in all subscales , indicating that OA was symptomatic . No difference in the KOOS between the graft types was found . Meniscus resection was a strong risk factor for OA of the medial compartment ( odds ratio , 3.6 ; 95 % CI , 1.4 - 9.3 ) in the multivariable logistic regression analysis . Conclusion : A 3-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee . No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found . An initial meniscus resection was a strong risk factor for OA ; the time between injury and reconstruction was not OBJECTIVE To determine the effect of weight and physical activity on the prevalence of radiological knee osteoarthritis ( OA ) in a cohort of middle-aged women . METHODS The longitudinal phase of the Melbourne Women 's Mid-life Health Project is a population -based prospect i ve study of 438 Australian-born women who have been followed annually over 11 years . Of these women , 257 ( 59 % ) remained in longitudinal assessment at eleventh year of followup , and 224 of these women agreed to undergo radiographs of their knees . Radiographs were scored for features of OA [ osteophytes and joint space narrowing ( JSN ) ] using a vali date d scale , by 2 investigators who were blinded to question naire results . Data were obtained by both self-administered and face-to-face interview question naires . RESULTS The average weight increase over the study period of 11 years was 4 kg ( range -14 to 25 kg ) . Of the 224 women evaluated , 65 ( 29 % ) had knee joint osteophytes and 95 ( 42 % ) had evidence of knee JSN . Current weight and weight at baseline were independent factors associated with a higher prevalence of both osteophytes and JSN in all compartments of the knee . The average amount of physical activity over the 11 years of followup was a significant factor independently associated with an increased prevalence of patellofemoral JSN and approached significance for tibiofemoral osteophytes and total knee JSN . CONCLUSION Our study supports a longterm detrimental effect of weight on the knee joint and suggests the importance of longterm weight maintenance programs in preventing knee OA . The average amount of physical activity was associated with an increased prevalence of some features of knee OA OBJECTIVES Foot orthoses are commonly used in the management of knee OA , although the relationship between foot function and knee OA is still unclear . The purpose of the study was to examine foot function during walking in people with and without medial compartment knee OA . METHODS Motion of the tibia , rearfoot and forefoot in 32 patients with medial compartment knee OA and 28 age-matched control subjects was investigated .  Multivariate analysis was used to compare the groups . RESULTS The knee OA group contacted the ground with a more everted rearfoot , demonstrated greater peak rearfoot eversion and exhibited reduced rearfoot frontal plane range of motion and reduced rearfoot peak inversion . The tibia was more internally rotated and laterally tilted throughout the gait cycle , with reduced peak external rotation . CONCLUSION People with medial compartment knee OA exhibit altered foot kinematics during gait that are indicative of a less mobile , more everted foot type . The presence and degree of tibial malalignment and the available rearfoot range of motion during walking may affect individual responses to load-altering interventions , such as foot orthoses and footwear modifications . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry , www.anzctr.org.au/ , ACTRN12608000116325
The majority of consistent gait deviations associated with KOA were exhibited by those with severe disease in the temporospatial domain .
There was a lack of evidence for alterations in the external knee adduction moment .
Individuals with KOA exhibit a range of gait deviations compared with controls .
Despite its common usage in KOA gait studies , we did not find consistent evidence that knee adduction moment differs between those with and without KOA or between disease severity levels .
OBJECTIVE To identify which gait deviations are consistently associated with knee osteoarthritis ( KOA ) and how these are influenced by disease severity , the involved compartment , and sex .