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Varus alignment of the hip and knee 2 years after anterior cruciate ligament injury is associated with medial tibiofemoral osteoarthritis 3 years later

Nilsson, Henrik LU ; Englund, Martin LU orcid ; Frobell, Richard LU ; Lohmander, L. Stefan LU orcid ; Struglics, André LU and Swärd, Per LU (2025) In Journal of Experimental Orthopaedics 12(1).
Abstract

Purpose: To investigate if hip and knee alignment assessed 2 years after anterior cruciate ligament (ACL) injury is associated with compartment-specific radiographic knee osteoarthritis (OA) 3 years later. Methods: An exploratory analysis was conducted in the knee ACL, nonsurgical versus surgical treatment (KANON) trial (ISRCTN84752559); 115 subjects with acute ACL injury were assessed at the 2-year follow-up; full-limb images of the injured leg were acquired, and the neck-shaft angle (NSA) and hip-knee-ankle angle (HKA) were measured. At the 5-year follow-up, weight-bearing tibiofemoral and patellofemoral radiographs were obtained. Radiographs were graded according to the OA Research Society International Atlas and Radiographic OA was... (More)

Purpose: To investigate if hip and knee alignment assessed 2 years after anterior cruciate ligament (ACL) injury is associated with compartment-specific radiographic knee osteoarthritis (OA) 3 years later. Methods: An exploratory analysis was conducted in the knee ACL, nonsurgical versus surgical treatment (KANON) trial (ISRCTN84752559); 115 subjects with acute ACL injury were assessed at the 2-year follow-up; full-limb images of the injured leg were acquired, and the neck-shaft angle (NSA) and hip-knee-ankle angle (HKA) were measured. At the 5-year follow-up, weight-bearing tibiofemoral and patellofemoral radiographs were obtained. Radiographs were graded according to the OA Research Society International Atlas and Radiographic OA was defined as approximating Kellgren & Lawrence grade 2 or worse. Analysis of covariance adjusting for sex, age, body mass index, randomization and partial meniscectomy recorded at the 2-year follow-up was performed. Results: In patients who had developed medial tibiofemoral OA at the 5-year follow-up, the NSA and the HKA at the 2-year follow-up were smaller (NSA, mean difference = −4.6° [95% confidence interval {CI} −7.9° to −1.1°]; HKA, mean difference = −2.3° [95% CI −4.2° to −0.4°]). No association was observed between the NSA or HKA at the 2-year follow-up and lateral tibiofemoral OA, nor patellofemoral OA at the 5-year follow-up. Conclusion: A smaller NSA and HKA angle of the ACL injured leg (i.e., more varus hip and varus knee alignment) 2 years after the injury was associated with medial tibiofemoral radiographic OA 3 years later. Level of Evidence: Level II exploratory post hoc analysis of an RCT.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
alignment, anterior cruciate ligament, hip knee ankle angle, neck-shaft angle, osteoarthritis
in
Journal of Experimental Orthopaedics
volume
12
issue
1
article number
e70143
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:39759097
  • scopus:85214107906
ISSN
2197-1153
DOI
10.1002/jeo2.70143
language
English
LU publication?
yes
id
cfb2a577-0d06-42b5-8801-e5d63828578a
date added to LUP
2025-03-25 14:53:07
date last changed
2025-05-06 16:09:35
@article{cfb2a577-0d06-42b5-8801-e5d63828578a,
  abstract     = {{<p>Purpose: To investigate if hip and knee alignment assessed 2 years after anterior cruciate ligament (ACL) injury is associated with compartment-specific radiographic knee osteoarthritis (OA) 3 years later. Methods: An exploratory analysis was conducted in the knee ACL, nonsurgical versus surgical treatment (KANON) trial (ISRCTN84752559); 115 subjects with acute ACL injury were assessed at the 2-year follow-up; full-limb images of the injured leg were acquired, and the neck-shaft angle (NSA) and hip-knee-ankle angle (HKA) were measured. At the 5-year follow-up, weight-bearing tibiofemoral and patellofemoral radiographs were obtained. Radiographs were graded according to the OA Research Society International Atlas and Radiographic OA was defined as approximating Kellgren &amp; Lawrence grade 2 or worse. Analysis of covariance adjusting for sex, age, body mass index, randomization and partial meniscectomy recorded at the 2-year follow-up was performed. Results: In patients who had developed medial tibiofemoral OA at the 5-year follow-up, the NSA and the HKA at the 2-year follow-up were smaller (NSA, mean difference = −4.6° [95% confidence interval {CI} −7.9° to −1.1°]; HKA, mean difference = −2.3° [95% CI −4.2° to −0.4°]). No association was observed between the NSA or HKA at the 2-year follow-up and lateral tibiofemoral OA, nor patellofemoral OA at the 5-year follow-up. Conclusion: A smaller NSA and HKA angle of the ACL injured leg (i.e., more varus hip and varus knee alignment) 2 years after the injury was associated with medial tibiofemoral radiographic OA 3 years later. Level of Evidence: Level II exploratory post hoc analysis of an RCT.</p>}},
  author       = {{Nilsson, Henrik and Englund, Martin and Frobell, Richard and Lohmander, L. Stefan and Struglics, André and Swärd, Per}},
  issn         = {{2197-1153}},
  keywords     = {{alignment; anterior cruciate ligament; hip knee ankle angle; neck-shaft angle; osteoarthritis}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Journal of Experimental Orthopaedics}},
  title        = {{Varus alignment of the hip and knee 2 years after anterior cruciate ligament injury is associated with medial tibiofemoral osteoarthritis 3 years later}},
  url          = {{http://dx.doi.org/10.1002/jeo2.70143}},
  doi          = {{10.1002/jeo2.70143}},
  volume       = {{12}},
  year         = {{2025}},
}