{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T10:01:34Z","timestamp":1790848894613,"version":"4.1.0"},"reference-count":119,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p>The onset and progression of knee osteoarthritis (KOA) are closely associated with abnormal mechanical loading. Previous research has focused largely on local biomechanical factors, such as lower-limb alignment and the knee adduction moment; however, these factors alone may not fully explain the discordance between radiographic degeneration and clinical manifestations such as pain and functional impairment. From a whole-kinetic-chain perspective, the knee functions as an intermediate link within the continuous spine-to-foot chain. Multisegmental malalignment involving the lumbar spine, pelvis, hip, and ankle-foot complex may shift the center of mass and alter the transmission of ground reaction forces, potentially interacting bidirectionally with local knee malalignment to redistribute joint loads and contribute to cartilage damage and pain. By examining the limitations of knee-centered biomechanical studies, we aim to synthesize evidence on the relationship between global alignment and KOA, explores how global-local load interactions may contribute to KOA progression, and proposes a conceptual framework in which the interplay between global and local malalignment may amplify mechano-inflammation and thereby promote disease progression. This review aims to provide new insights into biomechanical phenotyping, progression-risk assessment, and individualized mechanical interventions for KOA.<\/jats:p>","DOI":"10.3389\/fbioe.2026.1932171","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:41:44Z","timestamp":1790847704000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Biomechanics of knee osteoarthritis from local knee loading to whole kinetic chain imbalance: a narrative review"],"prefix":"10.3389","volume":"14","author":[{"given":"Junyang","family":"Tang","sequence":"first","affiliation":[{"name":"Affiliated Hospital of Changchun University of Chinese Medicine, Changchun University of Chinese Medicine","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhai","family":"Zhao","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Changchun University of Chinese Medicine, Changchun University of Chinese Medicine","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binghua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]},{"name":"Hebei Key Laboratory of Turbidity Toxin Syndrome","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e251129","DOI":"10.1148\/radiol.251129","article-title":"Ultra-processed foods and muscle fat infiltration at thigh MRI: data from the osteoarthritis initiative","volume":"319","author":"Akkaya","year":"2026","journal-title":"Radiology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1186\/s12891-026-09556-9","article-title":"Effectiveness of pelvic stabilization exercises on knee valgus, muscle activity, and strength in individuals with dynamic knee valgus","volume":"27","author":"Ambrus","year":"2026","journal-title":"BMC Musculoskelet. Disord."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2373","DOI":"10.1002\/jor.23908","article-title":"Changes in the total knee joint moment in patients with medial compartment knee osteoarthritis over 5 years","volume":"36","author":"Asay","year":"2018","journal-title":"J. Orthop. Res. Off. Publ. Orthop. Res. Soc."},{"key":"B4","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1097\/00003086-200206000-00022","article-title":"Scoring systems in total knee arthroplasty","volume":"399","author":"Bach","year":"2002","journal-title":"Clin. Orthop."},{"key":"B5","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1002\/acr.25327","article-title":"Gait alterations and association with worsening knee pain and physical function: a machine learning approach with wearable sensors in the multicenter osteoarthritis study","volume":"76","author":"Bacon","year":"2024","journal-title":"Arthritis Care Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"106619","DOI":"10.1016\/j.clinbiomech.2025.106619","article-title":"Determining the individual relationship between the step width and peak knee adduction moment during stepping in medial knee osteoarthritis","volume":"128","author":"Baghi","year":"2025","journal-title":"Clin. Biomech. Bristol Avon"},{"key":"B7","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1097\/BRS.0000000000004957","article-title":"Impact of hip and knee osteoarthritis on full body sagittal alignment and compensation for sagittal spinal deformity","volume":"49","author":"Balmaceno-Criss","year":"2024","journal-title":"Spine"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1017711","DOI":"10.3389\/fbioe.2022.1017711","article-title":"Knee adduction moment decomposition: toward better clinical decision-making","volume":"10","author":"Baniasad","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.3390\/life15081238","article-title":"Breaking down osteoarthritis: exploring inflammatory and mechanical signaling pathways","volume":"15","author":"Batarfi","year":"2025","journal-title":"Life"},{"key":"B10","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/1471-2474-9-116","article-title":"The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature","volume":"9","author":"Bedson","year":"2008","journal-title":"BMC Musculoskelet. Disord."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1479244","DOI":"10.3389\/frsip.2024.1479244","article-title":"Markerless vision-based knee osteoarthritis classification using machine learning and gait videos","volume":"4","author":"Ben Hassine","year":"2024","journal-title":"Front. Signal Process."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1770","DOI":"10.1136\/ard.2010.147082","article-title":"Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis","volume":"70","author":"Bennell","year":"2011","journal-title":"Ann. Rheum. Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e786","DOI":"10.5435\/JAAOS-D-24-00509","article-title":"The discordance between pain and imaging in knee osteoarthritis","volume":"33","author":"Bg","year":"2025","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1038\/s41413-024-00315-x","article-title":"Piezo1 expression in chondrocytes controls endochondral ossification and osteoarthritis development","volume":"12","author":"Brylka","year":"2024","journal-title":"Bone Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.gaitpost.2004.01.010","article-title":"Human movement analysis using stereophotogrammetry. Part 1: theoretical background","volume":"21","author":"Cappozzo","year":"2005","journal-title":"Gait Posture"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1002\/art.27377","article-title":"Frequency of varus and valgus thrust and factors associated with thrust presence in persons with or at higher risk of developing knee osteoarthritis","volume":"62","author":"Chang","year":"2010","journal-title":"Arthritis Rheum."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.1016\/j.joca.2013.08.007","article-title":"Varus thrust and knee frontal plane dynamic motion in persons with knee osteoarthritis","volume":"21","author":"Chang","year":"2013","journal-title":"Osteoarthr. Cartil."},{"key":"B18","doi-asserted-by":"publisher","first-page":"105953","DOI":"10.1016\/j.jbspin.2025.105953","article-title":"Piezo1 at the crossroads: mediating inflammation and mechanical stress in joint disorders","volume":"93","author":"Chen","year":"2026","journal-title":"Jt. Bone Spine"},{"key":"B19","doi-asserted-by":"publisher","first-page":"467","DOI":"10.14245\/ns.2346374.187","article-title":"From the spinopelvic parameters to global alignment and proportion scores in adult spinal deformity","volume":"20","author":"Cho","year":"2023","journal-title":"Neurospine"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1735","DOI":"10.1002\/acr.25050","article-title":"Relation of temporal asymmetry during walking to two-year knee pain outcomes in those with mild-to-moderate unilateral knee pain: an exploratory analysis from the multicenter osteoarthritis study","volume":"75","author":"Corrigan","year":"2023","journal-title":"Arthritis Care Res."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000001932","article-title":"The impact of knee flexion on global alignment in spinal deformity: a radiographic study","author":"Deveza","year":"2026","journal-title":"Clin. Spine Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"100683","DOI":"10.1016\/j.ocarto.2025.100683","article-title":"Defining and measuring varus thrust in knee osteoarthritis: a scoping review of current evidence and challenges","volume":"7","author":"Di Bacco","year":"2025","journal-title":"Osteoarthr. Cartil. Open"},{"key":"B23","doi-asserted-by":"publisher","first-page":"18342","DOI":"10.1038\/s41598-025-90804-8","article-title":"The impact of PCA derived gait kinematic variations on estimated medial knee contact forces in a knee osteoarthritis population","volume":"15","author":"Di Raimondo","year":"2025","journal-title":"Sci. Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e14","DOI":"10.1017\/erm.2021.16","article-title":"Integrins, cadherins and channels in cartilage mechanotransduction: perspectives for future regeneration strategies","volume":"23","author":"Dieterle","year":"2021","journal-title":"Expert Rev. Mol. Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2924","DOI":"10.1007\/s12325-024-02898-7","article-title":"Correlation between coronal position sequence of lumbar and WOMAC score in knee osteoarthritis (KOA) in standard standing position","volume":"41","author":"Du","year":"2024","journal-title":"Adv. Ther."},{"key":"B26","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/s13075-025-03573-0","article-title":"Chondrocyte lysates activate NLRP3 inflammasome-induced pyroptosis in synovial fibroblasts to exacerbate knee synovitis by downregulating caveolin-1","volume":"27","author":"Du","year":"2025","journal-title":"Arthritis Res. Ther."},{"key":"B27","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.otsr.2013.12.014","article-title":"Femoral and tibial bone torsions associated with medial femoro-tibial osteoarthritis. Index of cumulative torsions","volume":"100","author":"Duparc","year":"2014","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.joca.2012.09.012","article-title":"Osteoarthritis as a disease of mechanics","volume":"21","author":"Felson","year":"2013","journal-title":"Osteoarthr. Cartil."},{"key":"B29","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1016\/j.joca.2015.09.013","article-title":"Synovitis and the risk of knee osteoarthritis: the MOST study","volume":"24","author":"Felson","year":"2016","journal-title":"Osteoarthr. Cartil."},{"key":"B30","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1186\/s12891-023-06508-5","article-title":"Relationship between spinal imbalance and knee osteoarthritis by using full-body EOS","volume":"24","author":"Fu","year":"2023","journal-title":"BMC Musculoskelet. Disord."},{"key":"B31","doi-asserted-by":"publisher","first-page":"e508","DOI":"10.1016\/S2665-9913(23)00163-7","article-title":"Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the global burden of disease study 2021","volume":"5","author":"Culbreth","year":"2023","journal-title":"Lancet Rheumatol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1097\/00003677-200510000-00008","article-title":"The role of mechanical loading in the onset and progression of osteoarthritis","volume":"33","author":"Griffin","year":"2005","journal-title":"Exerc. Sport Sci. Rev."},{"key":"B33","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.gaitpost.2018.10.032","article-title":"Dynamic knee joint stiffness and contralateral knee joint loading during prolonged walking in patients with unilateral knee osteoarthritis","volume":"68","author":"Gustafson","year":"2019","journal-title":"Gait Posture"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10400435.2026.2659185","article-title":"Effect of an ankle-foot orthosis on gait parameters in medial knee osteoarthritis: a single-subject study","author":"Hajibabaei","year":"2026","journal-title":"Assist. Technol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"921","DOI":"10.3390\/diagnostics16060921","article-title":"Association between calcaneal inclination angle and spinal and lower limb alignment: a retrospective radiographic analysis","volume":"16","author":"Han","year":"2026","journal-title":"Diagnostics"},{"key":"B36","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1038\/s41584-021-00724-w","article-title":"Mechanosignalling in cartilage: an emerging target for the treatment of osteoarthritis","volume":"18","author":"Hodgkinson","year":"2022","journal-title":"Nat. Rev. Rheumatol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.jbiomech.2019.02.027","article-title":"Proximal gait adaptations in individuals with knee osteoarthritis: a systematic review and meta-analysis","volume":"87","author":"Iijima","year":"2019","journal-title":"J. Biomech."},{"key":"B38","doi-asserted-by":"publisher","first-page":"110","DOI":"10.3390\/bioengineering11020110","article-title":"Finding the goldilocks zone of mechanical loading: a comprehensive review of mechanical loading in the prevention and treatment of knee osteoarthritis","volume":"11","author":"Jahn","year":"2024","journal-title":"Bioengineering"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1271762","DOI":"10.3389\/fbioe.2023.1271762","article-title":"Double-edged role of mechanical stimuli and underlying mechanisms in cartilage tissue engineering","volume":"11","author":"Jia","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1007\/s00256-020-03550-5","article-title":"Obese and overweight individuals have greater knee synovial inflammation and associated structural and cartilage compositional degeneration: data from the osteoarthritis initiative","volume":"50","author":"Kanthawang","year":"2021","journal-title":"Skelet. Radiol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1055\/s-0042-1747947","article-title":"The influence of knee osteoarthritis on spinopelvic alignment and global sagittal balance","volume":"36","author":"Katsumi","year":"2023","journal-title":"J. Knee Surg."},{"key":"B42","doi-asserted-by":"publisher","first-page":"656","DOI":"10.3390\/s24020656","article-title":"A 0.05 m change in inertial measurement unit placement alters time and frequency domain metrics during running","volume":"24","author":"Kiernan","year":"2024","journal-title":"Sensors"},{"key":"B43","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1302\/0301-620X.108B7.BJJ-2025-0687.R2","article-title":"Coronal alignment parameters of the knee predict osteoarthritis development: a coronal plane alignment of the knee classification-based analysis using the multicenter osteoarthritis study data","author":"Kim","year":"2026","journal-title":"Bone Jt. J."},{"key":"B44","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1589\/jpts.29.996","article-title":"Relationship between trunk function evaluated using the trunk righting test and physical function in patients with knee osteoarthritis","volume":"29","author":"Kinoshita","year":"2017","journal-title":"J. Phys. Ther. Sci."},{"key":"B45","doi-asserted-by":"publisher","first-page":"100519","DOI":"10.1016\/j.xnsj.2024.100519","article-title":"Sagittal spinal alignment measurements and evaluation: historical perspective","volume":"19","author":"Knebel","year":"2024","journal-title":"North Am. Spine Soc. J."},{"key":"B46","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s12984-020-00685-3","article-title":"Validity and reliability of wearable inertial sensors in healthy adult walking: a systematic review and meta-analysis","volume":"17","author":"Kobsar","year":"2020","journal-title":"J. Neuro Engineering Rehabil."},{"key":"B47","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.jbiomech.2019.07.032","article-title":"Segmental foot and ankle kinematic differences between rectus, planus, and cavus foot types","volume":"94","author":"Kruger","year":"2019","journal-title":"J. Biomech."},{"key":"B48","doi-asserted-by":"publisher","first-page":"e81036","DOI":"10.1371\/journal.pone.0081036","article-title":"Knee adduction moment and medial contact force \u2013 facts about their correlation during gait","volume":"8","author":"Kutzner","year":"2013","journal-title":"PLoS One"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1097\/BRS.0000000000004646","article-title":"Quantifying the contribution of lower limb compensation to upright posture: what happens if adult spinal deformity patients do not compensate?","volume":"48","author":"Lafage","year":"2023","journal-title":"Spine"},{"key":"B50","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12984-024-01337-6","article-title":"Identifying changes in dynamic plantar pressure associated with radiological knee osteoarthritis based on machine learning and wearable devices","volume":"21","author":"Li","year":"2024","journal-title":"J. Neuroeng. Rehabil."},{"key":"B51","doi-asserted-by":"publisher","first-page":"917","DOI":"10.2519\/jospt.2019.8945","article-title":"Abnormal joint loading during gait in persons with hip osteoarthritis is associated with symptoms and cartilage lesions","volume":"49","author":"Liao","year":"2019","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"B52","doi-asserted-by":"publisher","first-page":"2490","DOI":"10.1007\/s10439-023-03289-9","article-title":"Bilateral asymmetry in knee and hip musculoskeletal loading during stair ascending\/descending in individuals with unilateral mild-to-moderate medial knee osteoarthritis","volume":"51","author":"Liu","year":"2023","journal-title":"Ann. Biomed. Eng."},{"key":"B53","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3390\/biology14010071","article-title":"NLRP3 inflammasome-mediated osteoarthritis: the role of epigenetics","volume":"14","author":"Liu","year":"2025","journal-title":"Biology"},{"key":"B54","doi-asserted-by":"publisher","first-page":"3550","DOI":"10.1007\/s00167-014-3222-z","article-title":"The association of dorsiflexion flexibility on knee kinematics and kinetics during a drop vertical jump in healthy female athletes","volume":"23","author":"Malloy","year":"2015","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1016\/j.joca.2015.02.779","article-title":"A more informed evaluation of medial compartment loading: the combined use of the knee adduction and flexor moments","volume":"23","author":"Manal","year":"2015","journal-title":"Osteoarthr. Cartil."},{"key":"B56","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1302\/2058-5241.6.210015","article-title":"Radiological assessment of lower limb alignment","volume":"6","author":"Marques Lu\u00eds","year":"2021","journal-title":"EFORT Open Rev."},{"key":"B57","doi-asserted-by":"publisher","first-page":"356","DOI":"10.3390\/jfmk10030356","article-title":"Estimation of the external knee adduction moment using inertial measurement unit sensors on the shank and lower back: a pilot study","volume":"10","author":"Matsuda","year":"2025","journal-title":"J. Funct. Morphol. Kinesiol."},{"key":"B58","doi-asserted-by":"publisher","first-page":"2275","DOI":"10.1093\/rheumatology\/ket298","article-title":"Foot posture, foot function and low back pain: the Framingham foot study","volume":"52","author":"Menz","year":"2013","journal-title":"Rheumatology"},{"key":"B59","doi-asserted-by":"publisher","first-page":"6975","DOI":"10.3390\/jcm13226975","article-title":"Radiological approach to assessment of lower-limb alignment\u2014coronal and transverse plane analysis","volume":"13","author":"Michalska-Foryszewska","year":"2024","journal-title":"J. Clin. Med."},{"key":"B60","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s12984-023-01198-5","article-title":"Assessing real-world gait with digital technology? Validation, insights and recommendations from the Mobilise-D consortium","volume":"20","author":"Mic\u00f3-Amigo","year":"2023","journal-title":"J. Neuro Eng. Rehabil."},{"key":"B61","doi-asserted-by":"publisher","first-page":"6460","DOI":"10.3390\/s22176460","article-title":"Applied assessment method for varus thrust during walking in patients with knee osteoarthritis using acceleration data measured by an inertial measurement unit","volume":"22","author":"Misu","year":"2022","journal-title":"Sensors"},{"key":"B62","doi-asserted-by":"publisher","first-page":"4578","DOI":"10.3390\/s23104578","article-title":"Association of the degree of varus thrust during gait assessed by an inertial measurement unit with patient-reported outcome measures in knee osteoarthritis","volume":"23","author":"Misu","year":"2023","journal-title":"Sensors"},{"key":"B63","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1136\/ard.61.7.617","article-title":"Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis","volume":"61","author":"Miyazaki","year":"2002","journal-title":"Ann. Rheum. Dis."},{"key":"B64","doi-asserted-by":"publisher","first-page":"8888","DOI":"10.1038\/s41598-023-35832-y","article-title":"Atlas-based finite element analyses with simpler constitutive models predict personalized progression of knee osteoarthritis: data from the osteoarthritis initiative","volume":"13","author":"Mononen","year":"2023","journal-title":"Sci. Rep."},{"key":"B65","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1038\/s41598-023-50481-x","article-title":"On the prediction of tibiofemoral contact forces for healthy individuals and osteoarthritis patients during gait: a comparative study of regression methods","volume":"14","author":"Moura","year":"2024","journal-title":"Sci. Rep."},{"key":"B66","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1016\/j.joca.2024.09.011","article-title":"Osteoarthritis year in review 2024: biomechanics","volume":"32","author":"M\u00fcndermann","year":"2024","journal-title":"Osteoarthr. Cartil."},{"key":"B67","doi-asserted-by":"publisher","first-page":"7343","DOI":"10.3390\/jcm14207343","article-title":"Body mass index and spinopelvic alignment as predictors of incident knee osteoarthritis: an 8-Year longitudinal study from the TOEI cohort of older Japanese women","volume":"14","author":"Murakami","year":"2025","journal-title":"J. Clin. Med."},{"key":"B68","doi-asserted-by":"publisher","first-page":"106939","DOI":"10.1016\/j.clinbiomech.2026.106939","article-title":"Asymmetric plantar loading during gait is prospectively associated with early changes in knee and hip pain in community-dwelling older adults","volume":"139","author":"Nakanowatari","year":"2026","journal-title":"Clin. Biomech."},{"key":"B69","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1016\/j.apmr.2024.10.015","article-title":"Center of pressure in relation to foot morphology and knee symptoms in older women with medial knee joint deformity: a cross-sectional study","volume":"106","author":"Nakazato","year":"2025","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"B70","doi-asserted-by":"publisher","first-page":"405","DOI":"10.3899\/jrheum.150559","article-title":"Variations in hip shape are associated with radiographic knee osteoarthritis: cross-sectional and longitudinal analyses of the Johnston county osteoarthritis project","volume":"43","author":"Nelson","year":"2016","journal-title":"J. Rheumatol."},{"key":"B71","doi-asserted-by":"publisher","first-page":"e23778","DOI":"10.1096\/fj.202400883R","article-title":"The chondrocyte \u201cmechanome\u201d: activation of the mechanosensitive ion channels TRPV4 and PIEZO1 drives unique transcriptional signatures","volume":"38","author":"Nims","year":"2024","journal-title":"FASEB J."},{"key":"B72","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.gaitpost.2015.04.018","article-title":"Three-dimensional dynamic analysis of knee joint during gait in medial knee osteoarthritis using loading axis of knee","volume":"42","author":"Nishino","year":"2015","journal-title":"Gait Posture"},{"key":"B73","doi-asserted-by":"publisher","first-page":"933","DOI":"10.3349\/ymj.2022.0184","article-title":"Knee extension is related to the posteriorly deviated gravity line to the pelvis in young adults: radiographic analysis using low-dose biplanar X-ray","volume":"63","author":"Park","year":"2022","journal-title":"Yonsei Med. J."},{"key":"B74","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13047-017-0187-4","article-title":"Plug-in-Gait calculation of the knee adduction moment in people with knee osteoarthritis during shod walking: comparison of two different foot marker models","volume":"10","author":"Paterson","year":"2017","journal-title":"J. Foot Ankle Res."},{"key":"B75","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s11420-011-9248-6","article-title":"Osteoarthritis as a whole joint disease","volume":"8","author":"Poole","year":"2012","journal-title":"HSS J. Musculoskelet. J. Hosp. Spec. Surg."},{"key":"B76","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1530\/EOR-24-0037","article-title":"Joint line and knee osteotomy","volume":"9","author":"Pratobevera","year":"2024","journal-title":"EFORT Open Rev."},{"key":"B77","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.gaitpost.2018.02.023","article-title":"The learning process of gait retraining using real-time feedback in patients with medial knee osteoarthritis","volume":"62","author":"Richards","year":"2018","journal-title":"Gait Posture"},{"key":"B78","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.1007\/s00256-022-04191-6","article-title":"Structural phenotypes of knee osteoarthritis: potential clinical and research relevance","volume":"52","author":"Roemer","year":"2023","journal-title":"Skelet. Radiol."},{"key":"B79","doi-asserted-by":"publisher","first-page":"112593","DOI":"10.1016\/j.jbiomech.2025.112593","article-title":"Kinetic effects of unicompartmental unloader braces in medial knee osteoarthritis: a longitudinal study of joint load during level, stair, and slope walking","volume":"184","author":"Rogoschin","year":"2025","journal-title":"J. Biomech."},{"key":"B80","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1016\/j.joca.2007.11.012","article-title":"Foot progression angle and the knee adduction moment: a cross-sectional investigation in knee osteoarthritis","volume":"16","author":"Rutherford","year":"2008","journal-title":"Osteoarthr. Cartil."},{"key":"B81","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.gaitpost.2025.07.319","article-title":"Acute effects of lateral wedge insoles on lower limb joint kinematics and symptoms in women with medial compartment knee osteoarthritis during walking","volume":"122","author":"Sabet","year":"2025","journal-title":"Gait Posture"},{"key":"B82","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1007\/s11926-014-0451-6","article-title":"The mechanobiology of articular cartilage: bearing the burden of osteoarthritis","volume":"16","author":"Sanchez-Adams","year":"2014","journal-title":"Curr. Rheumatol. Rep."},{"key":"B83","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1056\/NEJMcp1903768","article-title":"Osteoarthritis of the knee","volume":"384","author":"Sharma","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"B84","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1001\/jama.286.2.188","article-title":"The role of knee alignment in disease progression and functional decline in knee osteoarthritis","volume":"286","author":"Sharma","year":"2001","journal-title":"JAMA"},{"key":"B85","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1136\/ard.2010.129742","article-title":"Varus and valgus alignment and incident and progressive knee osteoarthritis","volume":"69","author":"Sharma","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"B86","doi-asserted-by":"publisher","first-page":"2136","DOI":"10.1002\/art.40224","article-title":"Varus thrust and incident and progressive knee osteoarthritis","volume":"69","author":"Sharma","year":"2017","journal-title":"Arthritis Rheumatol."},{"key":"B87","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1007\/s12306-025-00889-7","article-title":"Changes in spino-pelvis-lower extremity alignment in patients with knee osteoarthritis: a prospective radiographic study","volume":"109","author":"Singh","year":"2025","journal-title":"Musculoskelet. Surg."},{"key":"B88","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.knee.2022.12.007","article-title":"Prediction of knee adduction moment using innovative instrumented insole and deep learning neural networks in healthy female individuals","volume":"41","author":"Snyder","year":"2023","journal-title":"Knee"},{"key":"B89","doi-asserted-by":"publisher","first-page":"113443","DOI":"10.1016\/j.jbiomech.2026.113443","article-title":"Relationship between knee adduction moment and knee contact forces during walking and running with modified foot progression angles","volume":"205","author":"Subasinghe Arachchige","year":"2026","journal-title":"J. Biomech."},{"key":"B90","doi-asserted-by":"publisher","first-page":"19186","DOI":"10.1038\/s41598-023-46486-1","article-title":"Assessing knee joint biomechanics and trunk posture according to medial osteoarthritis severity","volume":"13","author":"Suzuki","year":"2023","journal-title":"Sci. Rep."},{"key":"B91","doi-asserted-by":"publisher","first-page":"23259671261450211","DOI":"10.1177\/23259671261450211","article-title":"Effects of medial opening-wedge high tibial osteotomy on 3-Dimensional knee joint biomechanics and trunk posture","volume":"14","author":"Suzuki","year":"2026","journal-title":"Orthop. J. Sports Med."},{"key":"B92","doi-asserted-by":"publisher","first-page":"2791","DOI":"10.1016\/j.jbiomech.2012.08.041","article-title":"The effect of contralateral pelvic drop and trunk lean on frontal plane knee biomechanics during single limb standing","volume":"45","author":"Takacs","year":"2012","journal-title":"J. Biomech."},{"key":"B93","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.1038\/s41598-021-82015-8","article-title":"Relationship of back muscle and knee extensors with the compensatory mechanism of sagittal alignment in a community-dwelling elderly population","volume":"11","author":"Takahashi","year":"2021","journal-title":"Sci. Rep."},{"key":"B94","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s13047-020-00426-8","article-title":"Associations of foot and ankle characteristics with knee symptoms and function in individuals with patellofemoral osteoarthritis","volume":"13","author":"Tan","year":"2020","journal-title":"J. Foot Ankle Res."},{"key":"B95","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1186\/s12891-022-05557-6","article-title":"Hip abductor strengthening in patients diagnosed with knee osteoarthritis \u2013 a systematic review and meta-analysis","volume":"23","author":"Thomas","year":"2022","journal-title":"BMC Musculoskelet. Disord."},{"key":"B96","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1177\/10538127251321767","article-title":"The relationship between spinopelvic alignment and knee osteoarthritis in female patients: a cross-sectional study","volume":"38","author":"Tomay Aksoy","year":"2025","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"B97","doi-asserted-by":"publisher","first-page":"111312","DOI":"10.1016\/j.jbiomech.2022.111312","article-title":"Personalization improves the biomechanical efficacy of foot progression angle modifications in individuals with medial knee osteoarthritis","volume":"144","author":"Uhlrich","year":"2022","journal-title":"J. Biomech."},{"key":"B98","doi-asserted-by":"publisher","first-page":"e708","DOI":"10.1016\/S2665-9913(25)00151-1","article-title":"Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial","volume":"7","author":"Uhlrich","year":"2025","journal-title":"Lancet Rheumatol."},{"key":"B99","doi-asserted-by":"publisher","first-page":"1176471","DOI":"10.3389\/fbioe.2023.1176471","article-title":"Diverse parameters of ambulatory knee moments differ with medial knee osteoarthritis severity and are combinable into a severity index","volume":"11","author":"Ulrich","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B100","doi-asserted-by":"publisher","first-page":"S36","DOI":"10.1016\/j.semarthrit.2019.09.018","article-title":"Mechanoflammation in osteoarthritis pathogenesis","volume":"49","author":"Vincent","year":"2019","journal-title":"Semin. Arthritis Rheum."},{"key":"B101","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1002\/jor.21142","article-title":"Decreased knee adduction moment does not guarantee decreased medial contact force during gait","volume":"28","author":"Walter","year":"2010","journal-title":"J. Orthop. Res."},{"key":"B102","doi-asserted-by":"publisher","first-page":"1842443","DOI":"10.3389\/fimmu.2026.1842443","article-title":"NF-\u03baB signaling in osteoarthritis: integrating mechanical stress, innate immunity, and cartilage degeneration","volume":"17","author":"Wan","year":"2026","journal-title":"Front. Immunol."},{"key":"B103","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1302\/2046-3758.55.2000538","article-title":"Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: a radiographic study","volume":"5","author":"Wang","year":"2016","journal-title":"Bone Jt. Res."},{"key":"B104","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.jare.2022.01.004","article-title":"Mechanical overloading induces GPX4-regulated chondrocyte ferroptosis in osteoarthritis via Piezo1 channel facilitated calcium influx","volume":"41","author":"Wang","year":"2022","journal-title":"J. Adv. Res."},{"key":"B105","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1038\/s41413-023-00248-x","article-title":"Mechanotransduction pathways in articular chondrocytes and the emerging role of estrogen receptor-\u03b1","volume":"11","author":"Wang","year":"2023","journal-title":"Bone Res."},{"key":"B106","doi-asserted-by":"publisher","first-page":"10225536231169575","DOI":"10.1177\/10225536231169575","article-title":"Why does knee flexion in the standing position occur? Spinal deformity or knee osteoarthritis","volume":"31","author":"Wang","year":"2023","journal-title":"J. Orthop. Surg."},{"key":"B107","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1016\/j.joca.2017.01.005","article-title":"Varus thrust during walking and the risk of incident and worsening medial tibiofemoral MRI lesions: the multicenter osteoarthritis study","volume":"25","author":"Wink","year":"2017","journal-title":"Osteoarthr. Cartil."},{"key":"B108","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1002\/acr.23766","article-title":"Association of varus knee thrust during walking with worsening WOMAC knee pain: the multicenter osteoarthritis study","volume":"71","author":"Wink","year":"2019","journal-title":"Arthritis Care Res."},{"key":"B109","doi-asserted-by":"publisher","first-page":"e86132","DOI":"10.7554\/eLife.86132","article-title":"Digital wearable insole-based identification of knee arthropathies and gait signatures using machine learning","volume":"13","author":"Wipperman","year":"2024","journal-title":"eLife"},{"key":"B110","doi-asserted-by":"publisher","first-page":"e70443","DOI":"10.1002\/jeo2.70443","article-title":"Proximal-dominant knee-ankle coordination compensations in football players with chronic ankle instability under high load","volume":"12","author":"Xian","year":"2025","journal-title":"J. Exp. Orthop."},{"key":"B111","doi-asserted-by":"publisher","first-page":"e58261","DOI":"10.2196\/58261","article-title":"Functional monitoring of patients with knee osteoarthritis based on multidimensional wearable plantar pressure features: cross-sectional study","volume":"7","author":"Xie","year":"2024","journal-title":"JMIR Aging"},{"key":"B112","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s43019-024-00226-5","article-title":"Impacts of asymmetric hip rotation angle on gait biomechanics in patients with knee osteoarthritis","volume":"36","author":"Yoon","year":"2024","journal-title":"Knee Surg. Relat. Res."},{"key":"B113","doi-asserted-by":"publisher","first-page":"5360","DOI":"10.3390\/jcm15145360","article-title":"Gait asymmetry in arm swing and foot progression angle of knee osteoarthritis","volume":"15","author":"Yoon","year":"2026","journal-title":"J. Clin. Med."},{"key":"B114","doi-asserted-by":"publisher","first-page":"6231406","DOI":"10.1155\/2021\/6231406","article-title":"A comparison of dynamic and static hip-knee-ankle angle during gait in knee osteoarthritis patients and healthy individuals","volume":"2021","author":"Zhang","year":"2021","journal-title":"Appl. Bionics Biomech."},{"key":"B115","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1186\/s12891-023-06437-3","article-title":"Comparison of accuracy for hip-knee-ankle (HKA) angle by X-ray and knee motion analysis system and the relationships between HKA and gait posture","volume":"24","author":"Zhang","year":"2023","journal-title":"BMC Musculoskelet. Disord."},{"key":"B116","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1177\/15353702231199079","article-title":"Primary cilium-mediated mechanotransduction in cartilage chondrocytes","volume":"248","author":"Zhang","year":"2023","journal-title":"Exp. Biol. Med."},{"key":"B117","doi-asserted-by":"publisher","first-page":"35303","DOI":"10.1038\/s41598-025-19371-2","article-title":"Cartilage mechanical responses during gait as in silico biomarkers for medial knee OA progression","volume":"15","author":"Zhang","year":"","journal-title":"Sci. Rep."},{"key":"B118","doi-asserted-by":"publisher","first-page":"1549812","DOI":"10.3389\/fcell.2025.1549812","article-title":"Implications of mechanosensitive ion channels in the pathogenesis of osteoarthritis: a comprehensive review","volume":"13","author":"Zhang","year":"","journal-title":"Front. Cell Dev. Biol."},{"key":"B119","doi-asserted-by":"publisher","first-page":"1760345","DOI":"10.3389\/fbioe.2026.1760345","article-title":"The mediating role of sacral slope in the relationship between lumbar lordosis and knee alignment in knee osteoarthritis: an imaging study","volume":"14","author":"Zhang","year":"2026","journal-title":"Front. Bioeng. Biotechnol."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1932171\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:41:45Z","timestamp":1790847705000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1932171\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":119,"alternative-id":["10.3389\/fbioe.2026.1932171"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2026.1932171","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"article-number":"1932171"}}