Relationship Between Varus-Valgus Alignment and Patellar Kinematics in Individuals with Knee Osteoarthritis

Background: Abnormal varus-valgus alignment is a risk factor for patellofemoral osteoarthritis, but tibiofemoral alignment alone does not explain compartmental patellofemoral osteoarthritis progression. Other mechanical factors, such as patellar kinematics, probably play a role in the initiation and progression of the disease. The objective of this study was to determine which three-dimensional patellar kinematic parameters (patellar flexion, spin, and tilt and patellar proximal, lateral, and anterior translation) are associated with varus and valgus alignment in subjects with osteoarthritis.

Methods: Ten individuals with knee osteoarthritis and varus (five subjects) or valgus (five subjects) knee alignment underwent assessment of three-dimensional patellar kinematics. We used a validated magnetic resonance imaging-based method to measure three-dimensional patellar kinematics in knee flexion while the subjects pushed against a pedal with constant load (80 N). A linear random-effects model was used to test the null hypothesis that there was no difference in the relationship between tibiofemoral flexion and patellar kinematics between the varus and valgus groups.

Results: Patellar spin was significantly different between groups (p = 0.0096), with the varus group having 2° of constant internal spin and the valgus group having 4.5° of constant external spin. In the varus group, the patellae tracked with a constant medial tilt of 9.6° with flexion, which was significantly different (p = 0.0056) from the increasing medial tilt (at a rate of 1.8° per 10° of increasing knee flexion) in the valgus group. The patellae of the valgus group were 7.5° more extended (p = 0.0093) and positioned 8.8 mm more proximally (p = 0.0155) than the varus group through the range of flexion that was studied. The pattern of anterior translation differed between the groups (p = 0.0011).

Conclusions: Our results suggest that authors of future large-scale studies of the relationships between knee mechanics and patellofemoral osteoarthritis should not rely solely on measurements of tibiofemoral alignment and should assess three-dimensional patellar kinematics directly.

Clinical Relevance: Direct measurements of patellar kinematics should be used to investigate links between patellofemoral joint mechanics and the development of patellofemoral osteoarthritis.