RT Journal Article
SR Electronic
T1 Obesity Is Associated with Greater Valgus Knee Alignment in Pubertal Children, and Higher Body Mass Index Is Associated with Greater Variability in Knee Alignment in Girls
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 126
OP 133
DO 10.3899/jrheum.131349
VO 42
IS 1
A1 Sharon Bout-Tabaku
A1 Justine Shults
A1 Babette S. Zemel
A1 Mary B. Leonard
A1 Robert I. Berkowitz
A1 Nicolas Stettler
A1 Jon M. Burnham
YR 2015
UL http://www.jrheum.org/content/42/1/126.abstract
AB Objective. In adults, osteoarthritis (OA) is associated with obesity and knee alignment. Whether knee alignment differences develop during childhood and are associated with obesity is unknown. We assessed the distribution of knee alignment in children and adolescents, and determined how knee alignment differs between obese and nonobese children. Methods. This cross-sectional study examined knee alignment in 155 healthy weight and 165 obese subjects. Knee alignment [metaphyseal-diaphyseal angle (MDA) and anterior tibiofemoral angle (ATFA)] and fat mass were measured using whole body dual-energy X-ray absorptiometry (DEXA). National reference data were used to generate age- and sex-specific body mass index (BMI, kg/m2) Z-scores. Multivariable linear regression was used to identify independent factors associated with ATFA and MDA. Results. The mean MDA and ATFA were similar between obese and nonobese subjects. In stratified analyses, females had greater variability in MDA and ATFA values (p < 0.001 and p = 0.04, respectively) at higher BMI Z-scores. Compared with healthy weight controls, obese subjects had less valgus of the MDA prior to the onset of puberty (+ 2.0°, p = 0.001), but had greater valgus at later pubertal stages (−1.9°, p = 0.01). Conclusion. We found significantly greater variability in knee alignment among females at higher BMI Z-scores, and greater valgus alignment in obese adolescents in late puberty. The major limitation is the use of DEXA for assessment of alignment, which needs validation against longstanding radiographs. Longitudinal studies are needed to determine whether childhood obesity is a risk factor for progressive malalignment that may predispose to pain and risk of early osteoarthritis.