The medial inclination of the proximal tibia is associated with the external knee adduction moment in advanced varus kne
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The medial inclination of the proximal tibia is associated with the external knee adduction moment in advanced varus knee osteoarthritis Tomoharu Mochizuki1 · Go Omori2 · Katsutoshi Nishino3 · Masaei Tanaka3 · Osamu Tanifuji1 · Hiroshi Koga1 · Takahiro Mori4 · Yoshio Koga5 · Hiroyuki Kawashima1 Received: 21 July 2020 / Accepted: 5 October 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose Whether the inclined articular surface on the medial proximal tibia and the external knee adduction moment (KAM) correlate remains unclear. The hypothesis was that a steeper inclined articular surface correlated with a larger KAM in advanced knee osteoarthritis (OA). Methods A total of 44 females (non-OA, 9 knees; early OA, 14 knees; advanced OA, 21 knees; mean age, 58 ± 16 years) were examined. Three-dimensional (3D) assessment was used on biplanar long-leg radiographs and 3D bone models using a 3D to 2D image registration technique. The approximation plane in the proximal tibia was determined using the least-square method. The joint moments were mathematically calculated in a gait analysis, applying a motion capture system and force plates. The main evaluation parameters were the femorotibial angle (FTA), the coronal inclination of the approximation plane in the medial proximal tibia (coronal inclination), and internal knee joint moments. The KAM means the external moments balanced with the internal knee abduction moments. Results The advanced OA showed a larger internal abduction moment (p = 0.017) at the loading response than the other groups. The larger FTA and steeper coronal inclination correlated with the larger internal abduction moment (FTA, p 20 years, capability of independent standing and walking, and healthy or medial knee OA. The exclusion criteria included subjects requiring a walking aid, such as a stick or another orthosis and subjects with a previous high tibial osteotomy or a total or unicompartmental knee arthroplasty, hip OA, or lateral knee OA. In total, 67 knee joints were collected, and this study excluded male participants because bone strength, muscle strength, activities, and many other factors in males differ from those in females. Finally, the study involved 37 female participants (44 knee joints), including seven healthy adults (9 knees) and 30 medial knee OA patients (35 knees). The average age was 58 years (range 21–80 years), and the average body mass index (BMI) was 24.5 kg/m2 (range 17.3–35.8 kg/m2). For the sample size calculation (α error, 0.05; 1 − β error, 0.80), 38 knees were needed to identify the differences in the KAM at the loading response among the groups. This study included a sufficient sample size (44 knees).
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A three-dimensional (3D) lower extremity alignment assessment system (Knee CAS, LEXI Inc., Tokyo, Japan) on biplanar long-leg X-rays was developed to assess lower extremity alignment and bony morphology. This system uses a 3D to 2D image registration technique [11, 25] and enables the automatic, strict meas
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