Patterns of cartilage degeneration in knees with medial tibiofemoral offset

To determine if radiographic medial tibiofemoral offset (MTFO) is associated with: (1) magnetic resonance imaging (MRI) pathology of cartilage, meniscus, and ligament; and (2) a distinct pattern of lateral cartilage degeneration on MRI.

Three hundred consecutive adult knee MRIs with anteroposterior (AP) radiographs were retrospectively reviewed, and 145 studies were included. MTFO was defined as a medial extension of the medial femoral condyle beyond the articular surface of the medial tibial plateau on weight-bearing AP radiographs. The patients were then divided into the MTFO (n = 61) or no-offset (n = 84) groups. On MRI data obtained on a 1.5-Tesla system, articular cartilage of the femoral condyle and tibial plateau were graded using a modified Outerbridge classification (36 sub-regions similar to whole-organ MRI Score (WORMS) system). In addition, MR pathology of the ACL, MCL, LCL, medial and lateral menisci, were determined.

Significantly increased (ANOVA p < 0.007) MR grade of the ligaments, menisci, and cartilage in the MTFO group (ranging from 0.3 to 2.5) compared to the control group (0.2 to 1.1). Color maps of the cartilage grades suggested a marked difference in both severity of degeneration and regional variations between the groups. MTFO group exhibited focally increased cartilage grades in the central, non-weight regions of lateral compartment (region p = 0.07 to 0.12, interaction p = 0.05 to 0.1).

MTFO is associated with overall degeneration of the knee and features a distinct lateral cartilage degeneration pattern, which may reflect non-physiologic contact of the cartilage between the lateral tibial eminence and lateral central femoral condyle.