"Varus knee dysfunction contributing to early medial knee arthritis: Novel pathomechanics, diagnosis and multi-modal conservative interventions".

Objective: Evaluate whether the three-planar spring test and pathomechanics-based interventions (manual therapy, strengthening, orthosis) increase the range of motion and explore potential changes in joint space of varus knee dysfunction, further investigating their potential association with the early development of medial knee arthritis (MKA).

Methods: Single group, pre-and post-test design. Adults (n = 54) exhibiting a positive spring test for varus knee dysfunction, characterised by extension lag with proximal tibia externally rotated and subluxed laterally, completed the study. Outcome measures include pain intensity, ROM, functional abilities and X-ray measures (joint space, tilt, and tibia position relative to the femur) following the interventions.

Results: After interventions, the spring test has become negative at the pre-assessment range. There is an increased ROM [internal rotation by 3.61° (95CI 3.22, 4.01) and extension by 3.92° (95CI -4.51, -3.33)], and X-ray measurements showed an increase in both medial and lateral joint space by 0.78 mm (95CI 0.63, 0.92) and 0.13 mm (95CI -0.03, 0.24) respectively. Additionally, total joint space expansion happened by 0.28 ± 0.23 mm. The proximal tibia medially shifted by 0.85 ± 0.96 mm, and the medial tilt was reduced by 1.79°±1.28°. A significant decrease in pain by five points (NPRS) and an increase in the overall functional abilities of participants by 36.9 points (95CI 34.72, 39.09).

Conclusion: The study results indicate that diagnosis with a spring test and interventions have increased the medial joint space and ROM, possibly improved alignment and synovial fluid, contributing to decreasing the pain and improving the functional abilities, thereby supporting the study's objective.