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Magnetic resonance imaged tibiofemoral contact in standing during toe-in and toe-out positions Cochrane, Christopher K.


Introduction: Knee osteoarthritis is a common, painful disease typically affecting the medial compartment of the tibiofemoral joint (TFJ). It is thought to result from excessive loading through the knee joint, and conservative treatments, like toe-in and toe-out gait modification, have been designed to alter the distribution of forces through the joint. Toe-in and toe-out have shown improvements in pain over the short-term, but it is not clear what changes actually occur within the TFJ. Since changes in orientation and contact between the tibia and femur would be indicative of altered loading in the TFJ, our goal was to examine the TFJ in standing with toe-in and toe-out positions using an open magnetic resonance scanner. Methods: This was a within-subjects study comparing tibiofemoral contact in standing in three foot positions (neutral, 0 degrees foot rotation; toe-in, 20 degrees internal rotation; and toe-out, 20 degrees external rotation). Fifteen young participants underwent magnetic resonance imaging of one of their knees. Images were analyzed to determine contact in the TFJ, with primary outcomes including centroid of contact and contact area for each compartment and overall. Results: The centroid of contact shifted laterally in the lateral compartment with the toe-in position compared to the neutral position (p = 0.05) while toe-out resulted in a lateral shift of the centroid of contact for the entire joint (p < 0.01). Contact area tended to increase in the lateral compartment for both toe-in and toe-out positions, while contact area in the medial compartment tended to decrease with toe-out, but increase with toe-in, when compared to the neutral position. Orientation of the shank was similar in flexion/extension and adduction/abduction while rotation showed statistically significant changes (p < 0.01), as expected. Study limb pressure was also similar between conditions. Conclusion: Findings from this study indicate that changes are present in the TFJ with toe-in and toe-out and that a lateralization of contact does occur as expected. This illustrates the potential for toe-in and toe-out gait modifications to alter the loading environment of the knee and has positive implications for their use as clinical treatment options for medial compartment knee osteoarthritis.

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