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The role of biomechanics in the initiation and progression of OA of the knee

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The knee is one of the most common joints affected by osteoarthritis (OA), frequently with clinical presentation by middle age or even earlier. Accumulating evidence supports that knee OA progression is often driven by biomechanical forces, and the pathological response of tissues to such forces leads to structural joint deterioration, knee symptoms and reduced function. Well-known biomechanical risk factors for progression include joint malalignment and meniscal tear. The high risk of OA after knee injury demonstrates the critical role of biomechanical factors also in incident disease in susceptible individuals. However, our knowledge of the contributing biomechanical mechanisms in the development of early disease and their order of significance is limited. Part of the problem is our current lack of understanding of early-stage OA, when it starts and how to define it.

Section snippets

Functional anatomy of the knee

The knee is the largest and one of the most complex joints. It comprises three distinct functional compartments: the patellofemoral joint, which consists of the patella and the patellar sulcus on the ventral femur, and the medial and lateral tibiofemoral compartments articulating the femur with the tibia (Fig. 2a and b). The articular cartilage on the joint surfaces supports low-friction motion and wear-resistant load transfer.

The two menisci are semicircular fibrocartilage structures located

Knee alignment

Knee alignment is often easy to measure but highly complex to fully understand in the causal chain of events in knee OA. Little is known about the contributing factors to altered alignment during the natural course of OA, although meniscal extrusion and maceration together with cartilage morphology are among the probable candidates [10]. Several measurements of alignment can be obtained using different techniques, for example, static hip–knee–ankle alignment measured on long leg films; anatomic

Meniscal injury

The treatment of meniscal injury has an interesting history that well illustrates the biomechanical problem the loss of meniscal function inflicts. In 1883, a British surgeon first successfully sutured a torn medial meniscus [17], but, 4 years later, he published yet another report, where he justified total removal of the meniscus rather than repair, and that view would prevail for over 80 years [18]. Already, in the late 1940s, Fairbank speculated that frequent radiographic changes found after

Anterior cruciate ligament injury

In contrast to meniscal injury, which normally does not give noticeable instability symptoms, the ACL injury may cause mechanical instability and reduced knee confidence in persons with a high activity level. The long-term consequences are also problematic. The reported risks of developing radiographic OA after ACL injury vary between 10% and 90% at 10–20 years after the ACL injury, the high variability mainly due to differences in study design [48]. However, considering that acute injury often

Occupational load and obesity

In epidemiological studies, heavy physical activity is associated with a higher risk of developing knee OA [53], *[54], [55], [56]. This may be due to a higher risk of joint injury in highly active individuals. However, excessive repetitive joint use appears to be associated with OA as well. Certain occupational kneeling has also been associated with increased frequency of knee OA, providing yet another evidence of the important role of biomechanics [57]. Interestingly, in parallel

Acknowledgements

I would like to thank Dr Ida K Haugen for helpful inputs to this article.

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