This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The influence of impairments in the local join-organ-level environment on OA progression rate or on patient-centered physical functioning has received little attention in epidemiologic study. Whether such impairments develop before or after OA onset, they may contribute to subsequent OA progression and/or functional decline. Meniscal tears and malalignment are local impairments which are present in a subset of patients with mild-moderate OA and adversely affect lad distribution. Another key element of the local environment is the functional capacity of the cartilage itself, i.e. its ability to withstand and transmit load. Our primary goal is to examine the relationship of meniscal tears and malalignment with compartment-specific tibiofemoral progression and with functional status decline in a cohort of 300 patients with knee OA. Secondarily, we will examine the impact of malalignment, laxity, muscle weakness and proprioception impairment on long-term (0-7 year) outcome. We also propose to measure cartilage deformation after exercise (which may be an in vivo measure of the functional capacity of cartilage) in a pilot study involving a subset of the cohort. A longitudinal, natural history study of knee OA with radiographic and functional outcomes is ongoing. Mechanical Factors in Arthritis of the Knee (MAK), in which time 0, 1.5 (completed), and 3-year (ongoing) evaluations of alignment, laxity, proprioception and strength in 300 subjects are funded. The current project builds upon the infrastructure and results of this study, with evaluations at five and seven years (on the MAK timeline). This study will provide much needed information regarding local determinates of the natural outcomes of knee OA and will help to identify the join-organ-level factors which should ultimately become the target of intervention, based upon their link to disease progression and/or their link to declining functional status.
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