Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Queensland University of Technology, Brisbane, QLD, Australia.
Cartilage. 2024 Jun;15(2):100-109. doi: 10.1177/19476035231186688. Epub 2023 Oct 17.
Mechanical alignment of the lower limbs has been suggested to cause abnormal uneven loading across the compartments at the knee, but its contribution to the initiation and progression of arthritis remains controversial. This study aimed to establish whether malalignment of the lower limb after trauma is associated with worsened arthritis scores in the theoretically overloaded compartment, and if arthritis scores continuously correlate with the degree of malalignment and time with deformity.
After screening 1160 X-rays, 60 patients were identified with long-leg radiographs > 2 years after fracture. Measurement of mechanical axis deviation (MAD) divided into groups of varus malalignment ( = 16, >16 mm), valgus ( = 25, <0 mm), and normal alignment ( = 19). Alignment and bilateral knee compartmental arthritis scores were recorded by three clinicians, compared via analysis of variance and assessed with linear regression against time since injury using MAD as a covariate.
In varus and valgus malalignment, there was a greater mean arthritis score in the "overloaded" compartment compared to the contralateral side, with varus medial Osteoarthritis Research Society International (OARSI) scores 5.17 ± 2.91 vs 3.50 ± 2.72 ( = 0.006) and Kellegren-Lawrence scores 2.65 ± 1.19 vs 1.79 ± 1.24 ( ≤ 0.001). In a linear regression model, OARSI arthritis score was significantly associated with absolute MAD (0.6/10 mm MAD, < 0.001) and time (0.7/decade, ≤ 0.001).
Malalignment consistently results in more advanced arthritis scores in the overloaded compartment, most likely related to abnormal loading across the knee. Severity of arthritis using OARSI grading continuously correlates with degree of malalignment and time with deformity after post-traumatic malunion.
下肢机械对线已被认为会导致膝关节各间室不均匀负重，但它对关节炎的发生和进展的影响仍存在争议。本研究旨在确定创伤后下肢对线不良是否与理论上过度负荷间室的关节炎评分恶化有关，以及关节炎评分是否与对线不良的程度和畸形持续时间连续相关。
在筛选了 1160 张 X 光片后，确定了 60 名患者的长下肢 X 光片>骨折后 2 年。将机械轴偏差（MAD）测量值分为内翻组（ = 16，>16mm）、外翻组（ = 25，<0mm）和正常组（ = 19）。通过三位临床医生记录对线和双侧膝关节间室关节炎评分，通过方差分析进行比较，并使用 MAD 作为协变量，通过线性回归评估与损伤后时间的关系。
在内翻和外翻对线不良中，“过度负荷”间室的关节炎评分均值高于对侧，内翻时内侧骨关节炎研究协会（OARSI）评分 5.17±2.91 与 3.50±2.72（ = 0.006），Kellgren-Lawrence 评分 2.65±1.19 与 1.79±1.24（ ≤ 0.001）。在线性回归模型中，OARSI 关节炎评分与绝对 MAD（0.6/10mm MAD， <0.001）和时间（0.7/十年， ≤ 0.001）显著相关。
对线不良始终导致过度负荷间室的关节炎评分更严重，这很可能与膝关节异常负荷有关。使用 OARSI 分级的关节炎严重程度与对线不良的程度和畸形持续时间后创伤性愈合不良连续相关。
