Varus alignment of the hip and knee 2 years after anterior cruciate ligament injury is associated with medial tibiofemoral osteoarthritis 3 years later. Nilsson, H., Englund, M., Frobell, R., Lohmander, L. S., Struglics, A., & Swärd, P. Journal of Experimental Orthopaedics, 12(1):e70143, January, 2025.
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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.
@article{nilsson_varus_2025,
	title = {Varus alignment of the hip and knee 2 years after anterior cruciate ligament injury is associated with medial tibiofemoral osteoarthritis 3 years later},
	volume = {12},
	issn = {2197-1153},
	doi = {10.1002/jeo2.70143},
	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 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.},
	language = {eng},
	number = {1},
	journal = {Journal of Experimental Orthopaedics},
	author = {Nilsson, Henrik and Englund, Martin and Frobell, Richard and Lohmander, L. Stefan and Struglics, André and Swärd, Per},
	month = jan,
	year = {2025},
	keywords = {alignment, anterior cruciate ligament, hip knee ankle angle, neck‐shaft angle, osteoarthritis},
	pages = {e70143},
}

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