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Association of bone scintigraphic abnormalities with knee malalignment and pain
  1. Virginia B Kraus (vbk{at}acpub.duke.edu)
  1. Duke University Medical Center, Department of Medicine, Durham, NC, United States
    1. Gary McDaniel (gary.mcdaniel{at}duke.edu)
    1. Duke University Medical Center, Department of Medicine, Durham, NC, United States
      1. Teddy W Worrell (tworrell{at}nc.rr.com)
      1. Duke University Medical Center, Department of Physical Therapy, Durham, NC, United States
        1. Sheng Feng (zfeng{at}fhcrc.org)
        1. Duke University Medical Center, Department of Bioinformatics, Durham, NC, United States
          1. T Parker Vail (vailt{at}orthosurg.ucsf.edu)
          1. Duke University Medical Center, Department of Surgery, Durham, NC, United States
            1. Gabor Varju (gabor.varju{at}gmail.com)
            1. Department of Medicine, East Carolina University, Greenville, NC, United States
              1. R Edward Coleman (colem010{at}mc.duke.edu)
              1. Duke University Medical Center, Department of Radiology, Durham, NC, United States

                Abstract

                Objective: We evaluated the information content of knee bone scintigraphy, including pattern, localization and intensity of retention relative to radiographic features of knee osteoarthritis (rOA), knee alignment, and knee symptoms.

                Methods: A total of 308 knees (159 subjects) with symptomatic and radiographic knee OA (rOA) of at least one knee were assessed by late phase technetium-99m-methylene disphosphonate bone scintigraph, fixed-flexion knee radiograph, full limb radiograph for knee alignment, and for self-reported knee symptom severity. Generalized linear models were used to control for within subject correlation of knee data.

                Results: The compartmental localization (medial versus lateral) and intensity of knee bone scan retention were associated with the pattern (varus versus valgus) (p<0.001) and severity (p=0.0008) of knee malalignment, and localization and severity of rOA (p<0.0001). Bone scan agent retention in the tibiofemoral, but not patellofemoral compartment, was associated with severity of knee symptoms (p=0.0009), and persisted after adjusting for rOA (p=0.0012).

                Conclusion: To our knowledge, this is the first study describing a relationship between knee malalignment, joint symptom severity, and compartment specific abnormalities by bone scintigraphy. This work demonstrates that bone scintigraphy as a sensitive and quantitative indicator of symptomatic knee OA. Used selectively, bone scintigraphy is a dynamic imaging modality that holds great promise as a clinical trial screening tool and outcome measure.

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