The Journal of Bone and Joint Surgery (American). 2009;91:85-89.
doi:10.2106/JBJS.H.01409
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Alignment and Osteoarthritis of the Knee

David J. Hunter, MBBS, PhD1, Leena Sharma, MD2 and Tyler Skaife, MD3

1 Division of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120. E-mail address: djhunter{at}caregroup.harvard.edu
2 Feinberg School of Medicine, Northwestern University, 240 East Huron Street, M300, Chicago, IL 60611
3 Division of Orthopedics, 800 Washington Street, Tufts Medical Center #306, Boston, MA 02111

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Osteoarthritis is widely believed to result from local mechanical factors acting within the context of systemic susceptibility. Previous studies have demonstrated that malalignment is a potent predictor of disease progression in patients with osteoarthritis of the knee. Malalignment also mediates the effects of other risk factors, including obesity, quadriceps strength, laxity, and stage of disease. Recent studies have had conflicting results regarding whether malalignment increases the risk of incident tibiofemoral osteoarthritis. While the evidence is conflicting, malalignment appears to play a smaller role in incident disease. Certain local factors within the joint, such as tibiofemoral congruence, integrity of the anterior cruciate ligament, and meniscal degeneration and position, appear to play a role in determining alignment. It is also apparent that malalignment changes with disease progression and is itself possibly influenced by structural changes within the joint.


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