Knee adduction moment is correlated with the increase in medial meniscus extrusion by dynamic ultrasound in knee osteoarthritis

Published:August 02, 2022DOI:



      An increase in medial meniscus extrusion (MME) due to abnormal biomechanical stress leads to knee osteoarthritis (OA) progression. MME evaluation during walking is a key method of detecting dynamic changes in the meniscus, and in combination with motion analysis, can provide a deeper understanding of the mechanisms involved in the increase of MME.


      To validate the feasibility of MME dynamic evaluation in combination with a motion analysis system based on the correlation between the increase in MME and biomechanical factors.


      Twenty-three knees from 23 patients with mild to moderate knee OA were analysed in this study. The medial meniscus during walking was evaluated by ultrasound. The increase in MME was calculated as the difference between the minimum and maximum MME during walking. A three-dimensional motion analysis system was synchronised with the ultrasound and then, biomechanical factors such as knee moment and ground reaction force were evaluated.


      The wave patterns of the mediolateral and vertical components of ground reaction forces and knee adduction moment were similar to those in the MME based on a high cross-correlation coefficient (>0.8). The increase in MME was significantly correlated with the peak value of the knee adduction moment (r = 0.54, P = 0.0073) but not with the mediolateral and vertical components of the ground reaction force.


      The findings show that knee adduction moment is correlated with an increase in MME during walking and indicates the validity and feasibility of the dynamic evaluation of MME in combination with a motion analysis system.


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        • Andriacchi T.P.
        • Koo S.
        • Scanlan S.F.
        Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee.
        J Bone Joint Surg Am. 2009; 91: 95-101
        • Walker P.S.
        • Arno S.
        • Bell C.
        • Salvadore G.
        • Borukhov I.
        • Oh C.
        Function of the medial meniscus in force transmission and stability.
        J Biomech. 2015; 48: 1383-1388
        • Costa C.R.
        • Morrison W.B.
        • Carrino J.A.
        Medial meniscus extrusion on knee MRI: Is extent associated with severity of degeneration or type of tear?.
        AJR Am J Roentgenol. 2004; 183: 17-23
        • Choi C.-J.
        • Choi Y.-J.
        • Lee J.-J.
        • Choi C.-H.
        Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear.
        Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2010; 26: 1602-1606
        • Lee D.W.
        • Ha J.K.
        • Kim J.G.
        Medial meniscus posterior root tear: a comprehensive review.
        Knee Surg Relat Res. 2014; 26: 125-134
        • Jones R.S.
        • Keene GCR
        • Learmonth DJA
        • Bickerstaff D.
        • Nawana N.S.
        • Costi J.J.
        • et al.
        Direct measurement of hoop strains in the intact and torn human medial meniscus.
        Clin Biomech Bristol Avon. 1996; 11: 295-300
        • Marzo J.M.
        • Gurske-DePerio J.
        Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications.
        Am J Sports Med. 2009; 37: 124-129
        • Patel R.
        • Eltgroth M.
        • Souza R.B.
        • Zhang C.A.
        • Majumdar S.
        • Link T.M.
        • et al.
        Loaded versus unloaded magnetic resonance imaging (MRI) of the knee: Effect on meniscus extrusion in healthy volunteers and patients with osteoarthritis.
        Eur J Radiol Open. 2016; 3: 100-107
        • Ishii Y.
        • Ishikawa M.
        • Kurumadani H.
        • Hayashi S.
        • Nakamae A.
        • Nakasa T.
        • et al.
        Increase in medial meniscal extrusion in the weight-bearing position observed on ultrasonography correlates with lateral thrust in early-stage knee osteoarthritis.
        J Orthop Sci. 2020; 25: 640-646
        • Ishii Y.
        • Ishikawa M.
        • Nakashima Y.
        • Hayashi S.
        • Kanemitsu M.
        • Kurumadani H.
        • et al.
        Association between medial meniscus extrusion under weight-bearing conditions and pain in early-stage knee osteoarthritis.
        J Med Ultrasonics. 2021; 48: 631-638
        • Paparo F.
        • Revelli M.
        • Piccazzo R.
        • Astengo D.
        • Camellino D.
        • Puntoni M.
        • et al.
        Extrusion of the medial meniscus in knee osteoarthritis assessed with a rotating clino-orthostatic permanent-magnet MRI scanner.
        Radiol Med (Torino). 2015; 120: 329-337
        • Murakami T.
        • Enokida M.
        • Kawaguchi K.
        • Otsuki R.
        • Nagashima H.
        Useful ultrasonographic evaluation of the medial meniscus as a feature predicting the onset of radiographic knee osteoarthritis.
        J Orthop Sci. 2017; 22: 318-324
        • Ishii Y.
        • Nakashima Y.
        • Ishikawa M.
        • Sunagawa T.
        • Okada K.
        • Takagi K.
        • et al.
        Dynamic ultrasonography of the medial meniscus during walking in knee osteoarthritis.
        Knee. 2020; 27: 1256-1262
        • Wink A.E.
        • Gross K.D.
        • Brown C.A.
        • Guermazi A.
        • Roemer F.
        • Niu J.
        • et al.
        Varus thrust during walking and the risk of incident and worsening medial tibiofemoral MRI lesions: The Multicenter Osteoarthritis Study.
        Osteoarthritis Cartilage. 2017; 25: 839-845
        • Chang A.
        • Hayes K.
        • Dunlop D.
        • Hurwitz D.
        • Song J.
        • Cahue S.
        • et al.
        Thrust during ambulation and the progression of knee osteoarthritis.
        Arthritis Rheum. 2004; 50: 3897-3903
        • Chang A.H.
        • Moisio K.C.
        • Chmiel J.S.
        • Eckstein F.
        • Guermazi A.
        • Prasad P.V.
        • et al.
        External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis.
        Osteoarthritis Cartilage. 2015; 23: 1099-1106
        • Miyazaki T.
        • Wada M.
        • Kawahara H.
        • Sato M.
        • Baba H.
        • Shimada S.
        Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis.
        Ann Rheum Dis. 2002; 61: 617-622
        • Davies-Tuck M.L.
        • Wluka A.E.
        • Teichtahl A.J.
        • Martel-Pelletier J.
        • Pelletier J.-P.
        • Jones G.
        • et al.
        Association between meniscal tears and the peak external knee adduction moment and foot rotation during level walking in postmenopausal women without knee osteoarthritis: A cross-sectional study.
        Arthritis Res Ther. 2008; 10: R58
        • Vanwanseele B.
        • Eckstein F.
        • Smith R.M.
        • Lange A.K.
        • Foroughi N.
        • Baker M.K.
        • et al.
        The relationship between knee adduction moment and cartilage and meniscus morphology in women with osteoarthritis.
        Osteoarthritis Cartilage. 2010; 18: 894-901
        • Mahmoudian A.
        • van Dieën J.H.
        • Bruijn S.M.
        • Baert I.A.C.
        • Faber G.S.
        • Luyten F.P.
        • et al.
        Dynamic and static knee alignment at baseline predict structural abnormalities on MRI associated with medial compartment knee osteoarthritis after 2 years.
        Gait Posture. 2017; 57: 46-51
        • Ishii Y.
        • Deie M.
        • Fujita N.
        • Kurumadani H.
        • Ishikawa M.
        • Nakamae A.
        • et al.
        Effects of lateral wedge insole application on medial compartment knee osteoarthritis severity evaluated by ultrasound.
        Knee. 2017; 24: 1408-1413
        • Hurwitz D.E.
        • Sumner D.R.
        • Andriacchi T.P.
        • Sugar D.A.
        Dynamic knee loads during gait predict proximal tibial bone distribution.
        J Biomech. 1998; 31: 423-430
        • Zhao D.
        • Banks S.A.
        • Mitchell K.H.
        • D’Lima D.D.
        • Colwell C.W.
        • Fregly B.J.
        Correlation between the knee adduction torque and medial contact force for a variety of gait patterns.
        J Orthop Res. 2007; 25: 789-797
        • Ogaya S.
        • Naito H.
        • Iwata A.
        • Higuchi Y.
        • Fuchioka S.
        • Tanaka M.
        Knee adduction moment and medial knee contact force during gait in older people.
        Gait Posture. 2014; 40: 341-345
        • Barile A.
        • Conti L.
        • Lanni G.
        • Calvisi V.
        • Masciocchi C.
        Evaluation of medial meniscus tears and meniscal stability: weight-bearing MRI vs arthroscopy.
        Eur J Radiol. 2013; 82: 633-639
        • Ishii Y.
        • Ishikawa M.
        • Hayashi S.
        • Kanemitsu M.
        • Omoto T.
        • Kurumadani H.
        • et al.
        The correlation between osteoarthritis stage and the effect of the lateral wedge insole for 3 months on medial meniscus extrusion in the knee joint.
        Knee. 2021; 28: 110-116
        • Kawaguchi K.
        • Enokida M.
        • Otsuki R.
        • Teshima R.
        Ultrasonographic evaluation of medial radial displacement of the medial meniscus in knee osteoarthritis.
        Arthritis Rheum. 2012; 64: 173-180
        • Furumatsu T.
        • Kodama Y.
        • Kamatsuki Y.
        • Hino T.
        • Okazaki Y.
        • Ozaki T.
        Meniscal extrusion progresses shortly after the medial meniscus posterior root tear.
        Knee Surg Relat Res. 2017; 29: 295-301
        • Okazaki Y.
        • Furumatsu T.
        • Shimamura Y.
        • Saiga K.
        • Ohashi H.
        • Uchino T.
        • et al.
        Time-Dependent Increase in Medial Meniscus Extrusion after Medial Meniscus Posterior Root Tear Analyzed by Using Magnetic Resonance Imaging.
        Knee Surg Relat Res. 2019; 31: 120-125
        • Karpinski K.
        • Diermeier T.
        • Willinger L.
        • Imhoff A.B.
        • Achtnich A.
        • Petersen W.
        No dynamic extrusion of the medial meniscus in ultrasound examination in patients with confirmed root tear lesion.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3311-3317
        • Bedi A.
        • Kelly N.H.
        • Baad M.
        • Fox A.JS.
        • Brophy R.H.
        • Warren R.F.
        • et al.
        Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy.
        J Bone Joint Surg Am. 2010; 92: 1398-1408
        • Astur D.C.
        • Novaretti J.V.
        • Gomes M.L.
        • Rodrigues A.G.
        • Kaleka C.C.
        • Cavalcante E.L.B.
        • et al.
        Medial opening wedge high tibial osteotomy decreases medial meniscal extrusion and improves clinical outcomes and return to activity.
        Orthop J Sports Med. 2020; 8
        • Lee S.H.
        • Lee O.-S.
        • Teo S.H.
        • Lee Y.S.
        Change in gait after high tibial osteotomy: A systematic review and meta-analysis.
        Gait Posture. 2017; 57: 57-68
        • Shaw K.E.
        • Charlton J.M.
        • Perry C.K.L.
        • de Vries C.M.
        • Redekopp M.J.
        • White J.A.
        • et al.
        The effects of shoe-worn insoles on gait biomechanics in people with knee osteoarthritis: a systematic review and meta-analysis.
        Br J Sports Med. 2018; 52: 238-253
        • Hinman R.S.
        • Bowles K.A.
        • Payne C.
        • Bennell K.L.
        Effect of length on laterally-wedged insoles in knee osteoarthritis.
        Arthritis Rheum. 2008; 59: 144-147
        • Simic M.
        • Wrigley T.V.
        • Hinman R.S.
        • Hunt M.A.
        • Bennell K.L.
        Altering foot progression angle in people with medial knee osteoarthritis: The effects of varying toe-in and toe-out angles are mediated by pain and malalignment.
        Osteoarthritis Cartilage. 2013; 21: 1272-1280