{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:34:42Z","timestamp":1777073682118,"version":"3.51.4"},"reference-count":42,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Varus mechanical alignment of the knee is a recognized contributor to medial compartment osteoarthritis (OA). Medial meniscus tears (MMT) frequently occur with knee OA. The present study aimed to analyze the association between mechanical alignment and MMT. We retrospectively analyzed 201 knee joints from patients with knee pain who underwent whole-leg weight-bearing radiographs and magnetic resonance imaging (MRI). Mechanical alignment was quantified using the hip\u2013knee\u2013ankle angle (HKAA), measured independently by two radiologists with excellent interrater reliability (intraclass correlation coefficient\u2009=\u20090.93). MMTs were assessed on MRI with high diagnostic agreement (\u03ba\u2009=\u20090.87). Based on MRI findings, participants were classified into two groups: those with MMT (n\u2009=\u2009104) and those without MMT (n\u2009=\u200997). Group comparisons were performed using t-tests and chi-square tests. Patients with MMT had greater varus alignment (HKAA: \u22126.2\u2009\u00b1\u20093.4 vs. \u22122.4\u2009\u00b1\u20091.4\u2009degrees, p\u2009&lt;\u20090.001), were older (53.7\u2009\u00b1\u20098.3 vs. 49.3\u2009\u00b1\u20099.0 years, p\u2009&lt;\u20090.001), and had higher body mass index (26.6\u2009\u00b1\u20093.0 vs. 25.2\u2009\u00b1\u20092.4\u2009kg\/m2, p\u2009=\u20090.001). Sex distribution did not differ between groups (p\u2009=\u20090.479). Logistic regression identified HKAA as the only independent predictor of MMT. When entered as a continuous variable, each additional degree of varus increased the odds of MMT nearly 2-fold (adjusted OR\u2009=\u20092.01, 95% confidence interval [CI]: 1.64\u20132.47, p\u2009&lt;\u20090.001). The complementary binary analysis showed that patients with varus alignment had over a 3-fold higher risk of MMT compared with those with neutral or valgus alignment (OR\u2009=\u20093.25, 95% CI: 1.85\u20135.72, p\u2009&lt;\u20090.001). Posterior horn tears were the most common subtype (47.1%), followed by multisite tears (33.7%). MMTs are strongly associated with varus mechanical alignment. Each incremental degree of varus increased the likelihood of MMT, and posterior horn tears were the most prevalent subtype. These findings highlight the pivotal role of mechanical alignment in the prevention, early detection, and management of MMT.<\/jats:p>","DOI":"10.1055\/a-2741-1676","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T23:58:31Z","timestamp":1764979111000},"page":"310-316","source":"Crossref","is-referenced-by-count":0,"title":["Association between Varus Mechanical Alignment and Medial Meniscus Tears: A Retrospective Study"],"prefix":"10.1055","volume":"39","author":[{"given":"Zhiheng","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Arthrosis, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"An","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Arthrosis, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhua","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Imaging, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5757-1029","authenticated-orcid":false,"given":"Xiaozuo","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Arthrosis, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juyuan","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Arthrosis, the Third Hospital of Hebei Medical 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Cooke","year":"2007","journal-title":"J Rheumatol"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.joca.2015.08.005","article-title":"Evidence that meniscus damage may be a component of osteoarthritis: the Framingham study","volume":"24","author":"M Englund","year":"2016","journal-title":"Osteoarthritis Cartilage"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.knee.2014.12.004","article-title":"Minor varus alignment provides better results than neutral alignment in medial UKA","volume":"22","author":"M Vasso","year":"2015","journal-title":"Knee"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"472","DOI":"10.3899\/jrheum.080732","article-title":"Optimizing limb position for measuring knee anatomical axis alignment from standing knee radiographs","volume":"36","author":"T D Cooke","year":"2009","journal-title":"J Rheumatol"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1002\/art.24383","article-title":"Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: the Multicenter Osteoarthritis Study","volume":"60","author":"M Englund","year":"2009","journal-title":"Arthritis Rheum"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1177\/0363546508326715","article-title":"Varus alignment leads to increased forces in the anterior cruciate ligament","volume":"37","author":"G J van de Pol","year":"2009","journal-title":"Am J Sports Med"},{"issue":"11","key":"ref17","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/j.joca.2010.07.012","article-title":"Cartilage and meniscus assessment using T1rho and T2 measurements in healthy subjects and patients with osteoarthritis","volume":"18","author":"Z A 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Sheehy","year":"2015","journal-title":"World J Rheumatol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"i3740","DOI":"10.1136\/bmj.i3740","article-title":"Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up","volume":"354","author":"N J Kise","year":"2016","journal-title":"BMJ"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.joca.2016.08.004","article-title":"The relationship between meniscal pathology and osteoarthritis depends on the type of meniscal damage visible on magnetic resonance images: data from the Osteoarthritis Initiative","volume":"25","author":"B Antony","year":"2017","journal-title":"Osteoarthritis Cartilage"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/1947603516654945","article-title":"Knee menisci","volume":"8","author":"J K Bryceland","year":"2017","journal-title":"Cartilage"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13018-017-0595-y","article-title":"Relationship between knee osteoarthritis and meniscal shape in observation of Japanese patients by using magnetic resonance imaging","volume":"12","author":"T Kawahara","year":"2017","journal-title":"J Orthop Surg Res"},{"issue":"07","key":"ref29","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.joca.2017.02.792","article-title":"Meniscal extrusion and bone marrow lesions are associated with incident and progressive knee osteoarthritis","volume":"25","author":"A J Teichtahl","year":"2017","journal-title":"Osteoarthritis Cartilage"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1186\/s12891-018-2335-9","article-title":"Mismatch between femur and tibia coronal alignment in the knee joint: classification of five lower limb types according to femoral and 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Bhan","year":"2020","journal-title":"Cureus"},{"issue":"11","key":"ref34","doi-asserted-by":"crossref","first-page":"2325967120967964","DOI":"10.1177\/2325967120967964","article-title":"Factors associated with patient satisfaction after opening-wedge high tibial osteotomy","volume":"8","author":"K Goshima","year":"2020","journal-title":"Orthop J Sports Med"},{"issue":"11","key":"ref35","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1056\/NEJMoa0800777","article-title":"Incidental meniscal findings on knee MRI in middle-aged and elderly persons","volume":"359","author":"M Englund","year":"2008","journal-title":"N Engl J Med"},{"issue":"03","key":"ref36","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.1097\/JSA.0000000000000329","article-title":"The epidemiology of meniscus injury","volume":"29","author":"B G Adams","year":"2021","journal-title":"Sports Med Arthrosc Rev"},{"key":"ref37","volume-title":"Anatomy, Bony Pelvis and Lower Limb, Medial Meniscus","author":"C Farrell","year":"2021"},{"issue":"06","key":"ref38","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1302\/2058-5241.6.210015","article-title":"Radiological assessment of lower limb alignment","volume":"6","author":"N Marques Lu\u00eds","year":"2021","journal-title":"EFORT Open Rev"},{"key":"ref39","volume-title":"Knee Meniscal Tears","author":"M A Raj","year":"2021"},{"issue":"05","key":"ref40","first-page":"e25121","article-title":"Meniscus tear: pathology, incidence, and management","volume":"14","author":"E Luvsannyam","year":"2022","journal-title":"Cureus"},{"issue":"02","key":"ref41","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4055\/cios20185","article-title":"Prognostic factors of mid- to long-term clinical outcomes after arthroscopic partial meniscectomy for medial meniscal tears","volume":"14","author":"S Y Hong","year":"2022","journal-title":"Clin Orthop 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