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Participants without radiographic abnormalities were divided into normal and EKOA groups according to the Luyten\u2019s classification criteria for EKOA. The medial proximal tibial angle (MPTA), growth plate\u2010TP angle, and growth plate\u2010medial tibial plateau (MTP) angle were measured on standing anteroposterior radiographs of the knees. BML severity on T2\u2010weighted fat\u2010suppressed magnetic resonance imaging (MRI) was scored using the Whole\u2010Organ MRI Score method. Serum levels of N\u2010telopeptide of type I collagen, tartrate\u2010resistant acid phosphatase\u20105b (TRACP\u20105b), bone\u2010specific alkaline phosphatase, procollagen type I N\u2010terminal propeptide, pentosidine, and homocysteine were assessed. Linear regression analysis was conducted to investigate the relationship between proximal tibial inclination, BML, and serum bone metabolic markers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The growth plate was observed in 309 (70%) participants, and 48 (16%) participants had EKOA. The mean MPTA, growth plate\u2010TP angle, and growth plate\u2010MTP angle were 86.1\u2009\u00b1\u20095.9\u00b0, 3.6\u2009\u00b1\u20091.1\u00b0, and 9.9\u2009\u00b1\u20092.6\u00b0, respectively. The MPTA was negatively correlated with the growth plate\u2010TP and growth plate\u2010MTP angles (<jats:italic>p<\/jats:italic>\u2009=\u20090.006, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Participants with EKOA who had BML exhibited greater growth plate\u2010MTP angle than those who did not (<jats:italic>p<\/jats:italic>\u2009=\u20090.018). Regression analysis revealed that BML severity was positively associated with MPTA (<jats:italic>p<\/jats:italic>\u2009=\u20090.036) and a bone formation marker (<jats:italic>p<\/jats:italic>\u2009=\u20090.045).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>BML severity was positively associated with proximal tibial inclination and serum TRACP\u20105b level in participants with EKOA and normal knees, respectively. Assessment of proximal tibial inclination may provide insight into potential BML risk. Residual medial tibial inclination may potentially result in knee pain and symptoms in EKOA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06378-7","type":"journal-article","created":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T09:03:47Z","timestamp":1609751027000},"page":"668-679","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Bone marrow lesion severity was associated with proximal tibial inclination in early knee osteoarthritis"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4426-2526","authenticated-orcid":false,"given":"Kyota","family":"Ishibashi","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine 5 Zaifu\u2010cho 036\u20108562 Hirosaki Aomori 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