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Medial-to-Lateral Ratio of Tibiofemoral Subchondral Bone Area is Adapted to Alignment and Mechanical Load

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Abstract

Malalignment is known to affect the medial-to-lateral load distribution in the tibiofemoral joint. In this longitudinal study, we test the hypothesis that subchondral bone surface areas functionally adapt to the load distribution in malaligned knees. Alignment (hip–knee–ankle angle) was measured from full limb films in 174 participants with knee osteoarthritis. Coronal magnetic resonance images were acquired at baseline and 26.6 ± 5.4 months later. The subchondral bone surface area of the weight-bearing tibiofemoral cartilages was segmented, with readers blinded to the order of acquisition. The size of the subchondral bone surface areas was computed after triangulation by proprietary software. The hip–knee–ankle angle showed a significant correlation with the tibial (r 2 = 0.25, P < 0.0001) and femoral (r 2 = 0.07, P < 0.001) ratio of medial-to-lateral subchondral bone surface area. In the tibia, the ratio was significantly different between varus (1.28:1), neutral (1.18:1), and valgus (1.13:1) knees (analysis of variance [ANOVA]; P < 0.00001). Similar observations were made in the weight-bearing femur (0.94:1 in neutral, 0.97.1 in varus, 0.91:1 in valgus knees; ANOVA P = 0.018). The annualized longitudinal increase in subchondral bone surface area was significant (P < 0.05) in the medial tibia (+0.13%), medial femur (+0.26%), and lateral tibia (+0.19%). In the medial femur, the change between baseline and follow-up was significantly different (ANOVA; P = 0.020) between neutral, varus, and valgus knees, with the increase in surface area being significantly greater (P = 0.019) in varus than in neutral knees. Tibiofemoral subchondral bone surface areas are shown to be functionally adapted to the medial-to-lateral load distribution. The longitudinal findings indicate that this adaptational process may continue to take place at advanced age.

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Acknowledgments

We thank Pottumarthi Prasad for his help with the image acquisition and Wolfgang Hitzl, Research Office of Paracelsus Medical University, for his help with the statistical analysis. We would also like to thank the following readers for their help with subchondral bone surface segmentation: Julia Bula-Sternberg, Gudrun Goldmann, Linda Jakobi, Verena Lengfelder, Ilona Lipp, Manuela Kunz, Dr. Susanne Maschek, Sabine Mühlsimer, Franz Romeder, Verena Stein, Annette Thebis, and Dr. Barbara Wehr. We thank NIH/NIAMS for funding this study through the following grants: RO1 AR48216, RO1 AR48748, P60 AR48098.

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Authors and Affiliations

  1. Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria

    Felix Eckstein & Martin Hudelmaier

  2. Chondrometrics GmbH, Ainring, Germany

    Felix Eckstein & Martin Hudelmaier

  3. Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    September Cahue, Meredith Marshall & Leena Sharma

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  1. Felix Eckstein
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Correspondence to Felix Eckstein.

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Eckstein, F., Hudelmaier, M., Cahue, S. et al. Medial-to-Lateral Ratio of Tibiofemoral Subchondral Bone Area is Adapted to Alignment and Mechanical Load. Calcif Tissue Int 84, 186–194 (2009). https://doi.org/10.1007/s00223-008-9208-4

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