E M Macri1, D T Felson2, M L Ziegler3, T D V Cooke4, A Guermazi5, F W Roemer6, T Neogi7, J Torner8, C E Lewis9, M C Nevitt10, J J Stefanik11. 1. Department of Physical Therapy, University of Delaware, Newark, DE, USA; Department of General Practice, Erasmus MC, Rotterdam, NL. Electronic address: e.macri@erasmusmc.nl. 2. Clinical Epidemiology Research and Training Unit, School of Medicine, Boston University, Boston, MA, USA; Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, UK. Electronic address: dfelson@bu.edu. 3. Biostatistics Core, College of Health Sciences, University of Delaware, Newark, DE, USA. Electronic address: mlz@udel.edu. 4. School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada. Electronic address: derek@cookes.ca. 5. Quantitative Imaging Center, Department of Radiology, School of Medicine, Boston University, Boston, MA, USA. Electronic address: Ali.Guermazi@bmc.org. 6. Quantitative Imaging Center, Department of Radiology, School of Medicine, Boston University, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany. Electronic address: Frank.Roemer@uk-erlangen.de. 7. Clinical Epidemiology Research and Training Unit, School of Medicine, Boston University, Boston, MA, USA. Electronic address: tneogi@bu.edu. 8. Department of Epidemiology, University of Iowa, Iowa City, IA, USA. Electronic address: james-torner@uiowa.edu. 9. Division of Preventive Medicine, University of Alabama, Birmingham, AL, USA. Electronic address: celewis@uabmc.edu. 10. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. Electronic address: MNevitt@psg.ucsf.edu. 11. Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA; Department of Physical Therapy, University of Delaware, Newark, USA. Electronic address: j.stefanik@northeastern.edu.
Abstract
OBJECTIVE: To determine the sex-specific relation of frontal plane alignment (FPA) to magnetic resonance imaging (MRI)-defined features of patellofemoral osteoarthritis, and also to tibiofemoral osteoarthritis and knee pain. METHOD: The Multicenter Osteoarthritis Study is cohort study comprised of individuals with or at risk of knee osteoarthritis. We determined the sex-specific dose-response relation of baseline FPA to MRI-defined patellofemoral and tibiofemoral structural worsening, and incident knee pain, over 7 years. RESULTS: In women only, greater varus alignment was associated with medial patellofemoral osteophytes (risk ratio [RR] 1.7 [95% CI 1.2, 2.6]) and valgus with lateral patellofemoral osteophytes (RR 1.9 [1.0, 3.6]). In men, greater varus increased risk for medial tibiofemoral cartilage worsening (RR 1.7 [1.1, 2.6]), and valgus for lateral tibiofemoral cartilage worsening (RR 1.8 [1.6, 2.2]). In women, findings were similar for tibiofemoral cartilage, but varus also increased risk for medial bone marrow lesions [BMLs] (RR 2.2 [1.6, 3.1]) and medial osteophytes (RR 1.8 [1.3, 2.5]), and valgus for lateral BMLs (RR 3.3 [2.2, 4.5]) and osteophytes (RR 2.0 [1.2, 3.2]). Varus increased risk of incident pain in men (RR 1.7 [1.4, 2.2]) and women (RR 1.3 [1.0, 1.6]), valgus did so in men only (RR 1.5 [1.1, 1.9]). CONCLUSION: FPA was associated with patellofemoral osteophyte worsening in women, though overall was more strongly associated with tibiofemoral than patellofemoral osteoarthritis feature worsening. FPA in women was more consistently associated with structural worsening, yet men had higher associations with incident pain.
OBJECTIVE: To determine the sex-specific relation of frontal plane alignment (FPA) to magnetic resonance imaging (MRI)-defined features of patellofemoral osteoarthritis, and also to tibiofemoral osteoarthritis and knee pain. METHOD: The Multicenter Osteoarthritis Study is cohort study comprised of individuals with or at risk of knee osteoarthritis. We determined the sex-specific dose-response relation of baseline FPA to MRI-defined patellofemoral and tibiofemoral structural worsening, and incident knee pain, over 7 years. RESULTS: In women only, greater varus alignment was associated with medial patellofemoral osteophytes (risk ratio [RR] 1.7 [95% CI 1.2, 2.6]) and valgus with lateral patellofemoral osteophytes (RR 1.9 [1.0, 3.6]). In men, greater varus increased risk for medial tibiofemoral cartilage worsening (RR 1.7 [1.1, 2.6]), and valgus for lateral tibiofemoral cartilage worsening (RR 1.8 [1.6, 2.2]). In women, findings were similar for tibiofemoral cartilage, but varus also increased risk for medial bone marrow lesions [BMLs] (RR 2.2 [1.6, 3.1]) and medial osteophytes (RR 1.8 [1.3, 2.5]), and valgus for lateral BMLs (RR 3.3 [2.2, 4.5]) and osteophytes (RR 2.0 [1.2, 3.2]). Varus increased risk of incident pain in men (RR 1.7 [1.4, 2.2]) and women (RR 1.3 [1.0, 1.6]), valgus did so in men only (RR 1.5 [1.1, 1.9]). CONCLUSION: FPA was associated with patellofemoral osteophyte worsening in women, though overall was more strongly associated with tibiofemoral than patellofemoral osteoarthritis feature worsening. FPA in women was more consistently associated with structural worsening, yet men had higher associations with incident pain.
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