Tanamas Stephanie, Hanna Fahad S, Cicuttini Flavia M, Wluka Anita E, Berry Patricia, Urquhart Donna M
Monash University, Alfred Hospital, Victoria, Australia.
Arthritis Rheum. 2009 Apr 15;61(4):459-67. doi: 10.1002/art.24336.
To systematically review the evidence for a relationship between malalignment of the knee joint and progression and/or development of knee osteoarthritis (OA).
Electronic searches of Medline, EMBase, and CINAHL were performed up to July 2008 using medical subject headings and free-text words. We included radiographic or magnetic resonance imaging (MRI) studies that met a set of predefined criteria. Two independent reviewers extracted the data and assessed the methodologic quality of the selected studies. Due to both heterogeneity and a limited number of studies, the results were summarized using a best evidence synthesis.
Fourteen studies met our inclusion criteria and 8 were considered high quality. We found limited evidence for an association between knee malalignment and incident knee OA, because only 1 cohort study examined this relationship. However, there was strong evidence based on 4 high-quality cohort studies that knee malalignment is an independent risk factor for progression of radiographic knee OA. This finding was further supported by 2 high-quality MRI cohort studies that found a relationship between varus and valgus alignment and structural progression of knee OA.
Malalignment of the knee joint was found to be an independent risk factor for the progression of knee OA. Given the paucity of investigation into the relationship between knee malalignment and risk of incident OA, further high-quality cohort studies are needed, and these may have important implications for the prevention of knee OA.
系统评价膝关节排列不齐与膝关节骨关节炎（OA）进展和/或发病之间关系的证据。
截至2008年7月，使用医学主题词和自由文本词对Medline、EMBase和CINAHL进行电子检索。我们纳入了符合一组预定义标准的X线或磁共振成像（MRI）研究。两名独立的评审员提取数据并评估所选研究的方法学质量。由于研究的异质性和数量有限，结果采用最佳证据综合法进行总结。
14项研究符合我们的纳入标准，其中8项被认为质量较高。我们发现膝关节排列不齐与膝关节OA发病之间的关联证据有限，因为只有1项队列研究考察了这种关系。然而，基于4项高质量队列研究有强有力的证据表明，膝关节排列不齐是X线膝关节OA进展的独立危险因素。2项高质量MRI队列研究发现内翻和外翻排列与膝关节OA结构进展之间存在关系，进一步支持了这一发现。
膝关节排列不齐是膝关节OA进展的独立危险因素。鉴于对膝关节排列不齐与OA发病风险之间关系的研究较少，需要进一步开展高质量的队列研究，这可能对膝关节OA的预防具有重要意义。
