title: High prevalence of contralateral ankle abnormalities in association with knee osteoarthritis and malalignment.
abstract: OBJECTIVE
  To evaluate ankle joint abnormalities in a knee osteoarthritis (OA) cohort.
  
  
  METHODS
  Participants (n = 159) with symptomatic and radiographic OA in at least one knee underwent technetium-99m methylene diphosphonate bone scan (scored 0-3) of the ankles and forefeet. Knee radiographs were graded for OA features of joint space narrowing (JSN) and osteophyte (OST). Ankle symptoms and history of ankle injury were assessed by self-report. Knee alignment was measured from a long-limb radiograph. Ankle radiographs were obtained on those who returned for follow-up (n = 138) and were graded for ankle tibiotalar JSN and OST.
  
  
  METHODS
  Ankle scintigraphic abnormalities were frequent (31% of individuals, one-third bilateral). Ankle symptoms were reported by 23% of individuals and history of ankle injury by 24%. Controlling for gender, age, body mass index (BMI), and contralateral predictor, ankle scintigraphic abnormalities were associated with: ipsilateral ankle symptoms (P = 0.005); contralateral knee JSN (P = 0.001), knee OST (P = 0.006) and knee malalignment (P = 0.08); and history of ankle injury or surgery of either ankle (P < 0.0001). At follow-up, scintigraphic abnormalities of the ankle were strongly associated with presence of tibiotalar radiographic OA (P < 0.0001).
  
  
  CONCLUSIONS
  Although considered rare, we observed a high prevalence of radiographic features of ankle OA in this knee OA cohort. History of overt ankle injury did not appear to account for the majority of ankle abnormalities. These results are consistent with a probable kinematic association of knee OA pathology and contralateral ankle abnormalities and suggest that interventions targeting mechanical factors may be needed to prevent ankle OA in the setting of knee OA.
authors.affiliation: Departments of Medicine, Duke University Medical Center, Durham, NC 27710, USA. Electronic address: vbk@duke.edu.
authors.forename: V B
authors.initials: VB
authors.lastname: Kraus
authors.forename: T W
authors.initials: TW
authors.lastname: Worrell
authors.forename: J B
authors.initials: JB
authors.lastname: Renner
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
authors.forename: C F
authors.initials: CF
authors.lastname: Pieper
mesh_terms: D000368:Aged; D016512:Ankle Injuries / Q000150:complications; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D017760:Bone Malalignment / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000209:etiology; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000000981:diagnostic imaging; D011859:Radiography; D011877:Radionuclide Imaging; D012307:Risk Factors
keywords: Alignment; Ankle; Knee; Osteoarthritis; Scintigraphy