Abstract
BackgroundInjury is an important risk factor for osteoarthritis (OA), a highly prevalent and disabling joint disease. Joint shape is linked to OA, but the interplay of injury and joint shape and their combined role in OA, particularly at the ankle, is not well known. Therefore, we explored cross-sectional associations between ankle shape and injury in a large community-based cohort.MethodsAnkles without radiographic OA were selected from the current data collection of the Johnston County OA Project. Ankles with self-reported prior injury were included as injury cases (n = 108) along with 1:1 randomly selected non-injured ankles. To define ankle shape, a 68 point model on weight-bearing lateral ankle radiographs was entered into a statistical shape model, producing a mean shape and a set of continuous variables (modes) representing variation in that shape. Nineteen modes, explaining 80% of shape variance, were simultaneously included in a logistic regression model with injury status as the dependent variable, adjusted for intra-person correlation, sex, race, body mass index (BMI), baseline OA radiographic grade, and baseline symptoms.ResultsA total of 194 participants (213 ankles) were included; mean age 71 years, BMI 30 kg/m2, 67% white and 71% women. Injured ankles were more often symptomatic and from whites. In a model adjusted only for intra-person correlation, associations were seen between injury status and modes 1, 6, 13, and 19. In a fully adjusted model, race strongly affected the estimate for mode 1 (which was no longer statistically significant).ConclusionsThis study showed variations in ankle shape and history of injury as well as with race. These novel findings may indicate a change in ankle morphology following injury, or that ankle morphology predisposes to injury, and suggest that ankle shape is a potentially important factor in the development of ankle OA.
Highlights
Injury is an important risk factor for osteoarthritis (OA), a highly prevalent and disabling joint disease
The changes in mode 19 were subtle and difficult to visualize using these methods, again suggested some shifts in alignment and interbone positioning. In this community-based cohort, we found that variations in ankle shape are associated with self-reported ankle injury and that there are racial differences in ankle
We have previously reported on racial differences in Statistical Shape Modeling (SSM) and geometric measures at the hip [13, 18, 19], but no comparable data exists at the ankle, and there are no epidemiologic studies exploring potential effects of race in ankle OA
Summary
Injury is an important risk factor for osteoarthritis (OA), a highly prevalent and disabling joint disease. Injury is a major risk factor for osteoarthritis (OA), a common chronic disease of the joint (cartilage, bone, and synovium) that is leading cause of disability among adults in the United States [1]. OA of the ankle [2] is less common than OA of other lower body joints, the etiology is predominantly posttraumatic [2], in contrast to “primary” OA most often seen in the hip and knee. There is a long latency period of around 20 years, between injury and end-stage ankle OA [6], a time when identification of those at risk could be key in preventing future disability [7]
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