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Characteristics of individual thigh muscles including cross-sectional area and adipose tissue content measured by magnetic resonance imaging in knee osteoarthritis: a cross-sectional study

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Abstract

This study aimed to identify the parameters related to the area and adipose tissue content of thigh muscles that are associated with radiographic knee osteoarthritis grade. Fifty patients (mean age ± standard deviation, 73.0 ± 4.5 years) were divided into early osteoarthritis (n = 23) and established osteoarthritis (n = 27) groups based on Kellgren–Lawrence classification. The femorotibial angle was measured from anteroposterior radiographs of the lower limbs. Individual thigh muscle and adipose tissue areas were analyzed using axial T1-weighted magnetic resonance imaging. After intergroup comparison, logistic regression analysis was performed to determine independent parameters associated with established osteoarthritis. Moreover, correlation coefficients were assessed between the left–right differences of osteoarthritis grade and parameters. Established osteoarthritis exhibited a significantly greater femorotibial angle and increased adipose tissue content in the subcutaneous, intermuscle, and intramuscle of the adductor, vastus lateralis, vastus intermedius, as well as a lower vastus medialis area, in comparison to early osteoarthritis. A greater femorotibial angle, increased intermuscular adipose tissue, and a lower vastus medialis area to knee extensor ratio were significantly independently associated with established osteoarthritis (odds ratio 3.2, 1.8, and 2.0, respectively). The left–right differences of femorotibial angle and vastus medialis area were significantly correlated with osteoarthritis grade, whereas adipose tissue content had no significant correlations with osteoarthritis grade. Greater femorotibial angle and lower vastus medialis area were related with higher osteoarthritis grade. Greater intermuscular adipose tissue content was associated with established osteoarthritis; however, in the left–right differences, adipose tissue content was not related with osteoarthritis grade.

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References

  1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2010) OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil 18:476–499. https://doi.org/10.1016/j.joca.2010.01.01

    Article  CAS  Google Scholar 

  2. Hudelmaier M, Glaser C, Hausschild A, Burgkart R, Eckstein F (2006) Effects of joint unloading and reloading on human cartilage morphology and function, muscle cross-sectional areas, and bone density—a quantitative case report. J Musculoskelet Neuronal Interact 6:284–290

    CAS  PubMed  Google Scholar 

  3. Winby CR, Lloyd DG, Besier TF, Kirk TB (2009) Muscle and external load contribution to knee joint contact loads during normal gait. J Biomech 42:2294–2300. https://doi.org/10.1016/j.jbiomech.2009.06.019

    Article  CAS  PubMed  Google Scholar 

  4. Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L (2008) Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc 40:422–427

    Article  PubMed  PubMed Central  Google Scholar 

  5. Segal NA, Glass NA (2011) Is quadriceps muscle weakness a risk factor for incident or progressive knee osteoarthritis? Phys Sportsmed 39:44–50. https://doi.org/10.1249/MSS.0b013e31815ef285

    Article  PubMed  Google Scholar 

  6. Blazevich AJ, Coleman DR, Horne S, Cannavan D (2009) Anatomical predictors of maximum isometric and concentric knee extensor moment. Eur J Appl Physiol 105:869–878. https://doi.org/10.1007/s00421-008-0972-7

    Article  PubMed  Google Scholar 

  7. Kumar D, Karampinos DC, MacLeod TD, Lin W, Nardo L, Li X, Link TM, Majumdar S, Souza RB (2014) Quadriceps intramuscular fat fraction rather than muscle size is associated with knee osteoarthritis. Osteoarthr Cartil 22:226–234. https://doi.org/10.1016/j.joca.2013.12.005

    Article  CAS  Google Scholar 

  8. Ruhdorfer AS, Dannhauer T, Wirth W, Cotofana S, Roemer F, Nevitt M, Eckstein F, OAI investigators (2014) Thigh muscle cross-sectional areas and strength in knees with early vs knees without radiographic knee osteoarthritis: a between-knee, within-person comparison. Osteoarthr Cartil 22:1634–1638. https://doi.org/10.1016/j.joca.2014.06.002

    Article  CAS  Google Scholar 

  9. Ruhdorfer A, Wirth W, Dannhauer T, Eckstein F (2015) Longitudinal (4 year) change of thigh muscle and adipose tissue distribution in chronically painful vs painless knees—data from the Osteoarthritis Initiative. Osteoarthr Cartil 23:1348–1356. https://doi.org/10.1016/j.joca.2015.04.004

    Article  CAS  Google Scholar 

  10. Dannhauer T, Sattler M, Wirth W, Hunter DJ, Kwoh CK, Eckstein F (2014) Longitudinal sensitivity to change of MRI-based muscle cross-sectional area versus isometric strength analysis in osteoarthritic knees with and without structural progression: pilot data from the Osteoarthritis Initiative. MAGMA 27:339–347. https://doi.org/10.1007/s10334-013-0418-z

    Article  CAS  PubMed  Google Scholar 

  11. Beattie KA, Macintyre NJ, Ramadan K, Inglis D, Maly MR (2012) Longitudinal changes in intermuscular fat volume and quadriceps muscle volume in the thighs of women with knee osteoarthritis. Arthritis Care Res (Hoboken) 64:22–29. https://doi.org/10.1002/acr.20628

    Article  Google Scholar 

  12. Dannhauer T, Ruhdorfer A, Wirth W, Eckstein F (2015) Quantitative relationship of thigh adipose tissue with pain, radiographic status, and progression of knee osteoarthritis: longitudinal findings from the osteoarthritis initiative. Invest Radiol 50:268–274. https://doi.org/10.1097/RLI.0000000000000113

    Article  PubMed  Google Scholar 

  13. Raynauld JP, Pelletier JP, Roubille C, Dorais M, Abram F, Li W, Wang Y, Fairley J, Cicuttini FM, Martel-Pelletier J (2015) Magnetic resonance imaging-assessed vastus medialis muscle fat content and risk for knee osteoarthritis progression: relevance from a clinical trial. Arthritis Care Res (Hoboken) 67:1406–1415. https://doi.org/10.1002/acr.22590

    Article  Google Scholar 

  14. Wang Y, Wluka AE, Berry P, Siew T, Teichtahl AJ, Urquhart DM, Lloyd DG, Jones G, Cicuttini FM (2012) Increase in vastus medialis cross-sectional area is associated with reduced pain, cartilage loss, and joint replacement risk in knee osteoarthritis. Arthritis Rheum 64:3917–3925. https://doi.org/10.1002/art.34681

    Article  PubMed  Google Scholar 

  15. Pan J, Stehling C, Muller-Hocker C, Schwaiger BJ, Lynch J, McCulloch CE, Nevitt MC, Link TM (2011) Vastus lateralis/vastus medialis cross-sectional area ratio impacts presence and degree of knee joint abnormalities and cartilage T2 determined with 3T MRI—an analysis from the incidence cohort of the Osteoarthritis Initiative. Osteoarthr Cartil 19:65–73. https://doi.org/10.1016/j.joca.2010.10.023

    Article  CAS  Google Scholar 

  16. Canale ST, Daugherty K, Jones L, Burns B (2003) Campbell’s operative orthopaedics, 10th edn. Mosby, Philadelphia, p 265

    Google Scholar 

  17. Akai M, Doi T, Fujino K, Iwaya T, Kurosawa H, Nasu T (2005) An outcome measure for Japanese people with knee osteoarthritis. J Rheumatol 32:1524–1532

    PubMed  Google Scholar 

  18. 18 Yamauchi K, Yoshiko A, Suzuki S, Kato C, Akima H, Kato T, Ishida K (2017) Estimation of individual thigh muscle volumes from a single-slice muscle cross-sectional area and muscle thickness using magnetic resonance imaging in patients with knee osteoarthritis. J Orthop Surg (Hong Kong) 25:2309499017743101. https://doi.org/10.1177/2309499017743101

    Article  Google Scholar 

  19. Yoshiko A, Hioki M, Kanehira N, Shimaoka K, Koike T, Sakakibara H, Oshida Y, Akima H (2017) Three-dimensional comparison of intramuscular fat content between young and old adults. BMC Med Imaging 17:12. https://doi.org/10.1186/s12880-017-0185-9

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sled JG, Zijdenbos AP (1998) A nonparametric method for automatic correction of intensity nonuniformity in MRI data. IEEE Trans Med Imaging 17:87–97

    Article  CAS  PubMed  Google Scholar 

  21. Sattler M, Dannhauer T, Ring-Dimitriou S, Sänger AM, Wirth W, Hudelmaier M, Eckstein F (2014) Relative distribution of quadriceps head anatomical cross-sectional areas and volumes–sensitivity to pain and to training intervention. Ann Anat 196:464–470. https://doi.org/10.1016/j.aanat.2014.07.005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, Pols HA, Bierma-Zeinstra SM (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56:1204–1211

    Article  CAS  PubMed  Google Scholar 

  23. Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S (2002) Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis 61:617–622

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Tetsworth K, Paley P (1994) Malalignment and degenerative arthropathy. Orthop Clin N Am 25:367–377

    CAS  Google Scholar 

  25. Schipplein OD, Andriacchi TP (1991) Interaction between active and passive knee stabilizers during level walking. J Orthop Res 9:113–119

    Article  CAS  PubMed  Google Scholar 

  26. Hurwitz DE, Ryals AB, Case JP, Block JA, Andriacchi TP (2002) The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res 20:101–107

    Article  CAS  PubMed  Google Scholar 

  27. Worlicek M, Moser B, Maderbacher G, Zentner R, Zeman F, Grifka J, Keshmiri A (2017) The influence of varus and valgus deviation on patellar kinematics in healthy knees: an exploratory cadaver study. Knee 24:711–717. https://doi.org/10.1016/j.knee.2017.04.009

    Article  PubMed  Google Scholar 

  28. Elias JJ, Kilambi S, Goerke DR, Cosgarea AJ (2009) Improving vastus medialis obliquus function reduces pressure applied to lateral patellofemoral cartilage. J Orthop Res 27:578–583. https://doi.org/10.1002/jor.20791

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bastick AN, Belo JN, Runhaar J, Bierma-Zeinstra SM (2015) What are the prognostic factors for radiographic progression of knee osteoarthritis? A meta-analysis. Clin Orthop Relat Res 473:2969–2989. https://doi.org/10.1007/s11999-015-4349-z

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sharma L, Dunlop DD, Cahue S, Song J, Hayes KW (2003) Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Ann Intern Med 138:613–619

    Article  PubMed  Google Scholar 

  31. Lim BW, Hinman RS, Wrigley TV, Sharma L, Bennell KL (2008) Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum 59:943–951. https://doi.org/10.1002/art.23823

    Article  PubMed  Google Scholar 

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Acknowledgements

We greatly appreciate Shigetoshi Suzuki, the staff of the radiology division for his assistance while conducting this study and the editors of American Journal Experts for correcting English language.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Akita Hospital, 2-6-12 Takara, Chiryu, Aichi, 472-0056, Japan

    Koun Yamauchi, Chisato Kato & Takayuki Kato

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  1. Koun Yamauchi
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  2. Chisato Kato
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  3. Takayuki Kato
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Contributions

CK study conception and design. TK study conception and design.

Corresponding author

Correspondence to Koun Yamauchi.

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Conflict of interest

Koun Y, Chisato K, and Takayuki K declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yamauchi, K., Kato, C. & Kato, T. Characteristics of individual thigh muscles including cross-sectional area and adipose tissue content measured by magnetic resonance imaging in knee osteoarthritis: a cross-sectional study. Rheumatol Int 39, 679–687 (2019). https://doi.org/10.1007/s00296-019-04247-2

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  • DOI: https://doi.org/10.1007/s00296-019-04247-2

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