Andriacchi et al. propose an integrated in vivo framework for how knee osteoarthritis starts and progresses, synthesizing gait analysis, quantitative MRI, and biomarker data. The central question: why does load harm OA cartilage but strengthen healthy cartilage, and what triggers the disease in the first place?
When evaluating a patient with early medial compartment OA or an ACL-deficient knee, think about rotational kinematics and adduction moment — not just axial load: interventions that restore normal knee rotation or reduce the adduction moment (HTO, gait retraining, bracing) are mechanistically justified in the Initiation Phase, while load reduction becomes the priority once cartilage has broken down and entered the Progression Phase.
Andriacchi et al. propose an integrated in vivo framework for how knee osteoarthritis starts and progresses, synthesizing gait analysis, quantitative MRI, and biomarker data. The central question: why does load harm OA cartilage but strengthen healthy cartilage, and what triggers the disease in the first place?
When evaluating a patient with early medial compartment OA or an ACL-deficient knee, think about rotational kinematics and adduction moment — not just axial load: interventions that restore normal knee rotation or reduce the adduction moment (HTO, gait retraining, bracing) are mechanistically justified in the Initiation Phase, while load reduction becomes the priority once cartilage has broken down and entered the Progression Phase.