Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

The Role of Varus and Valgus Alignment in the Initial Development of Cartilage Damage at the Knee: The MOST Study.

Sharma3,  Leena, Almagor4,  Orit, Chmiel4,  Joan S., Felson1,  David T., Guermazi2,  Ali, Roemer2,  Frank, Torner9,  James

Boston University, Boston, MA
Boston University
Northwestern University, Chicago, IL
Northwestern University
Queens University
UCSF, San Francisco, CA
University of Iowa


Varus and valgus alignment are each associated with subsequent progression of knee OA but their role in incident disease is less certain. Radiographic measures of incident OA cannot capture cartilage tissue change directly or reveal the compartment of initial disease. We identified knees with normal cartilage morphology by MRI in all tibial and femoral subregions at baseline to test the hypothesis: varus alignment is associated with incident medial cartilage damage and valgus alignment is associated with incident lateral cartilage damage.


MOST includes persons at risk for or with knee OA. In all participants, full-limb x-rays were acquired at baseline, and MRI (1.0T extremity system) at baseline and 30 months later. Varus malalignment was defined as <= 178° (hip-knee-ankle angle) and valgus as >= 182°. Cartilage and menisci were assessed using WORMS. In knees with normal baseline cartilage morphology (WORMS score 0 in all subregions), we used logistic regression with GEE to examine the association between baseline alignment and incident cartilage damage (WORMS score >= 2 at 30 months in >= 1 subregion) adjusting for age, gender, BMI, laxity, and meniscal tear and extrusion.


Of 1881 knees, 293 knees (110 varus, 55 valgus, 128 neutral) from 256 persons (mean age 60 years, BMI 28.6, 67% women) had normal cartilage morphology in all subregions at baseline. At 30 months, 34 had incident medial and 15 had incident lateral cartilage damage. As shown in Table 1, varus alignment was associated with a significantly increased risk of new medial cartilage damage vs. either reference group (non-varus or neutral) and when analyzed as a continuous variable. This relationship held even when knees with medial meniscal tear or extrusion were excluded (adjusted OR 1.37/1° varus, 95% CI 1.11, 1.68). Significant relationships were not detected for valgus and incident lateral disease (Table 2), possibly due in part to the low frequency of this outcome. In addition, varus was protective against incident lateral damage [adjusted OR 0.75/1°, 95% CI 0.59, 0.95] and valgus against incident medial damage [adjusted OR 0.72/1°, 95% CI 0.63, 0.83].

Table. Median daily minutes of physical activity intensity among n=1021 persons with radiographic knee OA

Unadjusted ResultsnMinutes No activity(0 counts)Minutes Light PA (1–2019 counts)Minutes MVPA(>=2020 counts)Minutes Any activity (>0 counts)
Men vs WomenDifference (95% CI)34.622.0, 47.2)-44.1-58.2, -30.1)8.6(6.1, 11.1)-32.3-46.5, -18.1)
Adjusted for Age, BMI, Race     
Men vs. WomenDifference (95% CI)32.917.3, 48.5)-42.7-55.3, -30.1)5.43.3, 7.5)-36.9-51.6, -22.1)

Table 2. Valgus Alignment (Baseline) and Incident Lateral Cartilage Defect (Outcome Variable) between Baseline and 30 Month Follow-up (n=293 knees with normal cartilage morphology at baseline)

AlignmentOR (95% CI) adjusted for age, gender, BMI, medial laxityOR (95% CI) adjusted for age, gender, BMI, medial laxity, lateral meniscal tear, lateral meniscal extrusion
Non-valgus (reference)referencereference
Valgus1.49 (0.40, 5.50)0.97 (0.26, 3.70)
Neutral (reference)referencereference
Valgus0.97 (0.25, 3.83)0.62 (0.14, 2.77)
Valgus (continuous), OR per 1*1.31 (1.04, 1.66)1.18 (0.94, 1.48)


In knees with normal cartilage morphology, varus alignment was associated with the initial development of cartilage damage in the more loaded compartment, and both varus and valgus were associated with a reduced risk of incident damage in the less loaded compartment. These results suggest that varus alignment is a risk factor for incident cartilage damage in knees without OA and provide further evidence that varus alignment increases the risk of incident knee OA.

To cite this abstract, please use the following information:
Sharma, Leena, Almagor, Orit, Chmiel, Joan S., Felson, David T., Guermazi, Ali, Roemer, Frank, et al; The Role of Varus and Valgus Alignment in the Initial Development of Cartilage Damage at the Knee: The MOST Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2100
DOI: 10.1002/art.29865

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