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Table 1 Study characteristics

From: Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis - a systematic review and meta-analysis

Study No. OA and control (% female) Group age, mean ± SD Group BMI, mean ± SD Definition OA Radiographic severity OA Compartment Biomechanical factor Risk of bias
Nordesjö (1983) OA:14 (85.7)
C:96 (47.9)
OA:68
C: NR
NR Radiographic NR Medial / lateral OA MUSC (extensor weakness; flexor weakness) High
Hall (1993) OA:21 (81.0)
C:21 (81.0)
OA:62.6 ± 13.9
C:62.2 ± 13.8
OA:29.6
C:25.5
Symptomatic NR Medial / lateral OA MUSC (extensor weakness; flexor weakness) High
Marks (1993) OA:10 (100)
C:10 (100)
OA: 54.6 ± 9.87
C:48.2 ± 6.97
OA:30.14
C:24.39
Symptomatic NR Medial / lateral OA PROP (reposition error) High
Marks (1996) OA:15 (100)
C:11 (100)
OA:60.07 ± 10.74
C:48.63 ± 6.77
NR Symptomatic NR Medial / lateral OA PROP (reposition error) High
Cooke (1997) OA:167 (54.4)
C:40 (65)
OA:66 ± 12
C:66 ± 8
NR Radiographic and symptomatic NR Medial / lateral OA MAL (varus) High
Pai (1997) OA:30 (73.3)
C:29 (58.6)
OA:68.2 ± 8.3
C:71.3 ± 8.3
OA:28.6 ± 4.1
C:24.9 ± 3.9
Radiographic KL2: 10, KL3: 13, KL4: 7 Medial / lateral OA PROP (TDPM) Low
Sharma (1997) OA:28 (53.6)
C:29 (55.2)
OA:65.5 ± 14.5
C:71 ± 11.5
OA:28.9 ± 5.8
C:26.3 ± 5.7
Radiographic KL2: 7, KL3: 12, KL4: 9 Medial / lateral OA PROP (TDPM) Low
Garsden (1999) OA:20 (50)
C:20 (50)
OA:62.8 (R 50–73)
C:60.8 (R 51–71)
NR Radiographic and symptomatic NR Medial / lateral OA PROP (reposition error) High
Cheing (2001) OA:66 (86.4)
C:10 (50)
OA:
women 63.5 ± 7.8;
men 63.9 ± 8.9
C: women 57.4 ± 6.6; men 62.4 ± 8.4
OA:
women 27.7 ± 4.2; men 26.3 ± 3.5
C: women 24.4 ± 1.8; men 25.5 ± 4.8
Radiographic NR Medial / lateral OA MUSC (extensor weakness; flexor weakness) Low
Kaufman (2001) OA:139 (66.2)
C:20 (55)
OA:57 ± 12.5
C:30 ± 8
OA:30.48
C:25.06
Radiographic and symptomatic NR Medial / lateral OA LOAD (KEM; KADM; KABM; KIRM; KERM) Low
Hortobagyi (2004) OA:20 (75)
C:20 (75)
OA:57.5 ± 7.3
C:56.8 ± 5
OA:29.3 ± 3.2
C:28.3 ± 3
Radiographic NR Medial / lateral OA PROP (reposition error) Low
Lewek (2004) OA:12 (41.7)
C:12 (50.0)
OA:52.6 ± 7.2
C:48.9 ± 4.9
OA:31.3 ± 5.1
C:28.6 ± 5.6
Radiographic and symptomatic NR Medial OA MUSC (extensor weakness) High
Lewek (2005) OA:21 (33.3)
C:19 (36.8)
OA:49.3 ± 7
C:49.3 ± 5.8
OA:30 ± 4.3
C:28.3 ± 4.9
Radiographic and symptomatic NR Medial OA Laxity (varus-valgus: medial; varus-valgus:lateral) High
Aoda (2006) OA:688 (NR)
C:568 (NR)
NR NR Radiographic KL2: 510, KL3: 136, KL4: 42 Medial / lateral OA LOAD (varus thrust) High
Hall (2006) OA with pain:36 (61.1)
OA without pain:23 (69.6)
C: 55 (69.1)
OA with pain: 68.78 ± 7.8
OA without pain: 69.22 ± 5.78
C:67.49 ± 8.45
OA with pain: 29.72 ± 4.4
OA without pain: 28.45 ± 4.69
C:25.89 ± 3.97
Radiographic and symptomatic NR Medial / lateral OA MUSC (extensor weakness); PROP (reposition error) Low
Zhai (2006) OA:239 (23.4)
C:261 (17.6)
OA:62.7 ± 7.1
C:63.0 ± 7.4
OA:28.7 ± 5.3 C:26.9 ± 4.1 Symptomatic NR Medial / lateral OA MUSC (extensor weakness) High
Ling (2007) OA:17 (NR)
C:22 (NR)
NR NR Radiographic KL2: 4, KL3: 9, KL4: 4 Medial / lateral OA MUSC (extensor weakness) Low
Petterson (2007) OA:44 (56.8)
C:44 (56.8)
OA:62.3 ± 6.8
C:61.3 ± 7.7
OA:27.9 ± 3.9
C:26.8 ± 4.4
Symptomatic NR Medial / lateral OA MUSC (extensor weakness) High
Rudolph (2007) OA:15 (46.7)
C:15 (46.7)
OA:49.2 (R 39–57)
C:49.2 (R 40–57)
OA:30.7 ± 4.8
C:28.7 ± 5.5
Symptomatic NR Medial OA MAL (varus) High
Schmitt (2007) OA:28 (50)
C:26 (50)
OA: 60.4 (R 39–78)
C: 58.5 (R 38–76)
OA:31.84
C:29.74
Radiographic NR Medial OA MAL (varus); MUSC (extensor weakness); Laxity (varus-valgus: medial; varus-valgus:lateral); LOAD (KFM; KEM: KADM) Low
Thorp (2007) OA:52 (73.1)
C:37 (73.0)
OA:56.2 ± 10.4
C:53.6 ± 6.1
OA:29.1 ± 3.9
C:26.7 ± 3.9
Radiographic NR Medial OA LOAD (KADM) Low
Zhai (2007) OA:56 (NR)
C:259 (NR)
NR NR Radiographic NR Medial / lateral OA MAL (varus; valgus) High
Astephen (2008) OA:61 (54.1)
C:60 (61.7)
OA:64.49 ± 7.75
C:50.27 ± 10.09
OA:32.05 ± 5.48
C:25.45 ± 4.04
Radiographic and symptomatic NR Medial / lateral OA LOAD (KFM; KIRM) High
Janakiramanan (2008) OA:74 (64)
C:128 (78)
OA:59.4 ± 8.5
C:63.8 ± 10
OA:29.4 ± 5.3
C:26.8 ± 4.8
Radiographic NR Medial / lateral OA MAL (valgus) Low
Liikavainio (2008) OA:54 (0)
C:53 (0)
OA:59 ± 5.3
C:59.2 ± 4.7
OA:29.7 ± 4.7
C:27.1 ± 3.1
Symptomatic KL1: 12, KL2: 15, KL3: 19, KL4: 8d Medial / lateral OA MUSC (extensor weakness; flexor weakness) Low
Lund (2008) OA:21 (100)
C:29 (100)
OA:57.1 ± 12
C:55.3 ± 10.1
OA:28.5 ± 7.4
C:23.3 ± 7.4
Radiographic and symptomatic NR Medial / lateral OA PROP (reposition error; TDPM) Low
Mohammadi (2008) OA:30 (100)
C:30 (100)
OA:46.4 ± 5.1
C:45.4 ± 4.9
OA:27.1 ± 3.3
C:26.9 ± 4.3
Symptomatic KL1/2: 5, KL3/4: 26d, e Medial / lateral OA MUSC (extensor weakness); PROP (reposition error) Low
Wu (2008) OA:11 (72.7)
C:10 (70.0)
OA:61.1 ± 10.3
C:61.4 ± 6.5
OA:24.4 ± 2.4 C:23.2 ± 2.2 Radiographic NR Medial / lateral OA MUSC (extensor weakness) High
Heiden (2009a) OA:54 (55.6)
C:27 (66.7)
OA:65.6 ± 7.6
C:64.2 ± 5.1
OA:28.1 ± 4.2
C:24.4 ± 3.6
Radiographic NR Medial / lateral OA LOAD (KEM; KADM) Low
Heiden (2009b) OA:54 (55.6)
C:27 (66.7)
OA:57 ± 10
C:56 ± 15
OA:29 ± 7
C:25 ± 4
Radiographic NR Medial / lateral OA MUSC (extensor weakness) Low
Chang (2010) OA:2026 (57.5)
C:1566 (58.7)
OA:63.4 ± 9.1
C:61.0 ± 8.9
OA:29.4 ± 4.8
C:27.6 ± 4.6
Radiographic NR Medial / lateral OA MUSC (extensor weakness); LOAD (valgus and varus thrust) Low
Cibere (2010) OA:98 (53)
C:33 (52)
OA M:65
C M:47
OA M:26.6
C M:24.1
Symptomatic NR Medial / lateral OA MAL (varus; valgus) High
Dixon (2010) OA:37 (62)
C:11 (64)
OA: 65.6 ± 9.2
C:57.3 ± 9.5
OA:29.5 ± 4.1
C:25.3 ± 3.1
Radiographic and symptomatic KL1: 3, KL2: 9, KL3: 10, KL4: 15d Medial OA LOAD (KEM) High
Foroughi (2010) OA:17 (100)
C:17 (100)
OA:66 ± 8
C:51 ± 7
OA:26 ± 3
C:25 ± 4
Symptomatic NR Medial OA MAL (varus); MUSC (extensor weakness); LOAD (KADM) Low
Linley (2010) OA:40 (57.5)
C:40 (57.5)
OA:63 ± 10
C:64 ± 9
OA:27.4 ± 5.5
C:24 ± 3.2
Radiographic and symptomatic KL1: 4, KL2: 20, KL3: 9, KL4: 7d Medial OA LOAD (KADM) Low
Creaby (2010) mild OA:
50 (54.0)
moderate OA: 45 (44.4)
severe OA:
32 (34.4)
C:32 (53.1)
mild OA: 61.61 ± 7.12 moderate OA: 65.23 ± 7.72
severe OA: 66.4 ± 9.39
C:59.39 ± 6.92
mild OA: 28.37 ± 4.72 moderate OA: 30.03 ± 4.31
severe OA: 29.72 ± 5.2
C:26.62 ± 2.82
Radiographic and symptomatic NR Medial OA Laxity (varus-valgus: medial; varus-valgus:lateral) Low
Berger (2011) OA:8 (50)
C:8 (50)
OA:61.3 ± 3.8
C:61.8 ± 5.9
OA:33.4 ± 4.6
C:27.0 ± 27.31
Radiographic and symptomatic NR Medial / lateral OA MUSC (extensor weakness) High
Butler (2011) MOA:15 (NR)
LOA:15 (NR)
C:15 (NR)
MOA:66.2 ± 7.8
LOA:65.7 ± 6.4
C:56.3 ± 10.7
MOA:32.2 ± 7.9
LOA:30.4 ± 7.5
C:27.8 ± 5.7
Radiographic MOA: KL2: 5, KL3: 4, KL4: 6
LOA: KL2: 3, KL3: 5, KL4: 7
Medial and lateral OA LOAD (KADM) Low
Cammarata (2011) OA:13 (46.2)
C:14 (50)
OA:57 ± 10
C:56 ± 15
OA:29 ± 7
C:25 ± 4
Radiographic and symptomatic NR Medial / lateral OA MUSC (extensor weakness; flexor weakness) Low
Zeni (2011) OA:30 (NR)
C:15 (NR)
OA:63 ± 7
C:58 ± 9
OA:29.75 ± 4.2
C:25.58 ± 3.5
Radiographic NR Medial OA MUSC (extensor weakness, flexor weakness) High
Cammarata (2012) OA:13 (46.2)
C:14 (50)
OA:57 ± 10
C:56 ± 15
OA:29 ± 7
C:25 ± 4
Radiographic and symptomatic NR Medial / lateral OA PROP (TDPM-varus; TDPM-valgus) Low
Conroy (2012) OA with pain: 170 (59)
OA without pain: 91 (58)
C:334 (58)
OA with pain: 74.1 ± 3.1
OA without pain: 73.7 ± 2.9
C:73.3 ± 2.7
OA with pain: 30.1 ± 4.8
OA without pain: 30.5 ± 5
C:26.4 ± 4.3
Radiographic and symptomatic NR Medial / lateral OA MUSC (extensor weakness) High
Fallah-Yakhdani (2012) OA:16 (68.8)
C:12 (58.3)
OA:62.3 ± 10.7
C:62.0 ± 12.6
OA:29.7 ± 4.1
C:29.4 ± 4.9
Symptomatic NR Medial / lateral OA MAL (varus; valgus) High
Levinger (2012) OA:32 (50)
C:28 (53.6)
OA:65.8 ± 7.5
C:65.2 ± 11.4
OA:29.9 ± 5.2
C:25.5 ± 3.9
Radiographic NR Medial OA LOAD (KADM) Low
Miyazaki (2012) mild OA:
20 (100)
advanced OA:26 (100)
C:22 (100)
mild OA:
3.8 ± 9.2
advanced OA: 74.1 ± 7.9
C:71.8 ± 8.3
mild OA:
22.6 ± 2
advanced OA: 23.5 ± 2.9
C:23.6 ± 2.2
Radiographic KL2: 20, KL3: 16, KL4: 10 Medial OA MUSC (extensor weakness); Laxity (anterior-posterior) Low
Baert (2013a) OA:24 (100)
C:20 (100)
OA:64 ± 7.5
C:62.9 ± 8
OA:27.8 ± 4
C:25.2 ± 3.6
Symptomatic KL2: 11, KL3: 8, KL4: 5 Medial / lateral OA MUSC (extensor weakness; flexor weakness); PROP (reposition error) Low
Baert (2013b) OA:12 (100)
C:14 (100)
OA:68.3 ± 6.8
C:65.8 ± 9.9
OA:28.6 ± 4.1
C: 24.8 ± 3.2
Symptomatic KL2: 7, KL3: 3, KL4: 2 Medial OA MAL (varus; valgus); MUSC (extensor weakness) Low
Kumar (2013) OA:16 (50)
C:12 (50)
OA:65.2 ± 9.5
C:59.5 ± 10.4
OA:28.6 ± 4.3 C:28.4 ± 5.2 Radiographic NR Medial OA MUSC (extensor weakness) Low
Maly
(2013a)b
OA:73 (100)
C:52 (100)
OA:64.6 ± 6.7
C:60.7 ± 7.1
OA:29.1 ± 4.7
C:26.4 ± 5.0
Radiographic NR Medial OA MUSC (extensor weakness) Low
Maly (2013b) OA:31 (29.0)
C:30 (53.3)
OA:53.2 ± 6.1
C:33.5 ± 8
OA:30.6 ± 4.3
C:25 ± 4.2
Radiographic and symptomatic KL2: 14, KL3: 13, KL4: 4 Medial OA LOAD (KADM) High
Metcalfe (2013) OA:20 (45)
C:20 (50)
OA:69 ± 7.2
C:68.3 ± 5.9
OA:31.1 ± 3.5
C:26.3 ± 3.6
Radiographic and symptomatic KL3: 7, KL4: 13 Medial OA LOAD (KADM) High
Perry (2013) OA:19 (52.6)
C:17 (47.1)
OA:69.9 ± 6.5
C:66.8 ± 6.4
OA:29.8 ± 3.83
C:28.9 ± 4.7
Symptomatic NR Medial / lateral OA MUSC (extensor weakness) High
Sagawa (2013)c OA:90 (58.9)
C:52 (n = 26) (53.8)
OA:68 ± 7
C:66 ± 8
OA:30.4 ± 5.2
C:23.4 ± 2.3
Radiographic and symptomatic NR Medial / lateral OA LOAD (KADM) Low
Chang (2014) OA:14 (57)
C:14 (57)
OA:60 ± 8.7
C:58.4 ± 9.5
OA:30.5 ± 8
C:23.9 ± 3.1
Radiographic and symptomatic NR Medial OA PROP (TDPM-varus; TDPM-valgus) Low
Duffell (2014a) OA:18 (NR)
C:18 (NR)
OA:56.4 ± 12.4
C:56.2 ± 13
OA:26.61
C:24.13
Radiographic and symptomatic NR Medial OA LOAD (KADM) High
Duffell (2014b) OA:15 (13.3)
C:9 (44.4)
OA:54
C:31
OA:25.7
C:22.2
Symptomatic NR Medial / lateral OA MAL (valgus) High
Favre (2014) OA:26 (62)
C:27 (44)
OA:62 ± 10
C:57 ± 8
OA:29 ± 5
C:27 ± 3
Radiographic and symptomatic NR Medial OA LOAD (KFM; KEM) Low
Kumar (2014) OA:30 (50)
C:66 (57.6)
OA:57.7 (R:54.3–61.1)
C:50.7 (R:48.4–53.1)
OA:26.9 (R:23.5–30.2)
C:24.1 (R:23.2–25)
Radiographic and symptomatic KL2: 10, KL3: 16, KL4: 4 Medial / lateral OA MUSC (extensor weakness, flexor weakness) Low
Winters (2014) OA:26 (46.2)
C:23 (47.8)
OA:65.3 ± 7.8
C:63.1 ± 7.7
OA:30.6 ± 4.6
C:25.8 ± 3.8
Radiographic KL1: 7, KL2: 10, KL3: 10d, f Medial OA MUSC (extensor weakness); LOAD (KFM; KADM) High
  1. Legend: OA patients with knee osteoarthritis, C control group, NR not reported, R range, M median, SD standard deviation, MAL skeletal malalignment, MUSC muscular dysfunction, PROP impaired proprioception, LAX laxity, LOAD abnormal loading, TDPM threshold to detect a passive movement, KFM knee flexion moment, KEM knee extension moment, KADM knee adduction moment, KABM knee abduction moment, KIRM knee internal rotation moment, KERM knee external rotation moment, KL Kellgren and Lawrence grade. a This value seems not realistic, but it was stated in the published report, b Muscle strength was assessed for n = 115, c In controls 52 legs were assessed, d Patients with KL 1 were included in the osteoarthritis group as selection was based on other inclusion criteria such as pain, e Number of patients calculated from percentage, f 27 patients with radiographic severity reported, while 26 osteoarthritis patients are included in the study