Varus alignment of the hip and knee 2 years after anterior cruciate ligament injury is associated with medial tibiofemoral osteoarthritis 3 years later
2025

Hip and Knee Alignment After ACL Injury and Osteoarthritis Risk

Sample size: 115 publication Evidence: moderate

Author Information

Author(s): Henrik Nilsson, Martin Englund, Richard Frobell, L. Stefan Lohmander, André Struglics, Per Swärd

Primary Institution: Lund University

Hypothesis

A higher neck‐shaft angle (NSA) and valgus alignment of the ACL injured knee would be associated with the development of lateral tibiofemoral osteoarthritis, whereas a smaller NSA and varus alignment would be associated with medial tibiofemoral osteoarthritis.

Conclusion

A smaller NSA and HKA angle of the ACL injured leg 2 years after the injury was associated with medial tibiofemoral radiographic osteoarthritis 3 years later.

Supporting Evidence

  • Patients with medial tibiofemoral OA had smaller NSA and HKA angles at the 2-year follow-up.
  • No association was found between alignment and lateral tibiofemoral or patellofemoral OA.
  • The study included 115 patients with a mean age of 26.2 years.

Takeaway

If your knee and hip are more bent inward after an ACL injury, you might get arthritis in your knee later on.

Methodology

An exploratory analysis was conducted in the KANON trial with 115 subjects assessed at 2 years and followed up with radiographs at 5 years.

Potential Biases

Factors such as meniscal pathology and cartilage loss may bias findings related to knee alignment.

Limitations

The low prevalence of compartment-specific OA suggests a high risk of statistical type II errors.

Participant Demographics

Mean age of 26.2 years, 26% women, mean BMI of 24.1.

Statistical Information

P-Value

0.02 for HKA, <0.01 for NSA

Confidence Interval

HKA: 95% CI −4.2° to −0.4°; NSA: 95% CI −7.9° to −1.1°

Statistical Significance

p<0.05

Digital Object Identifier (DOI)

10.1002/jeo2.70143

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