Contribution of knee adduction moment impulse to pain and disability in Japanese women with medial knee osteoarthritis.

BACKGROUND An increase in the knee adduction moment is one of the risk factors of medial knee osteoarthritis. This study examined the relationship between knee adduction moment and self-reported pain and disability. We also investigated the influence of pain on the relationships between knee adduction moment and gait performance and disability. METHODS Thirty-eight Japanese women with medial knee osteoarthritis participated in this study (66.37 years (41-79 years)). Gait analysis involved the measurement of the external knee adduction moment impulse in the stance duration and during 3 subdivisions of stance. The total, pain and stiffness, and physical function Japanese Knee Osteoarthritis Measure scores were determined. FINDINGS The pain and stiffness, physical function, and total scores were positively correlated with the knee adduction moment impulses in the stance duration, and initial and second double support interval, and single limb support interval. The knee adduction moment impulse during the stance duration was related to the pain and stiffness subscale and gait velocity. The pain and stiffness subscale was related to the physical function subscale. INTERPRETATION Our results suggest that increasing in the knee adduction moment impulse, a proxy for loading on the medial compartment of the knee, is related to increased pain during weight-bearing activities such as walking, thereby restricting walking performance and causing disability by reducing gait velocity. Thus, the reduction in the knee adduction moment impulse during gait may result in pain relief and may serve as a conservative treatment option with disease-modifying potential.

[1]  R. Moskowitz,et al.  Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. , 1986, Arthritis and rheumatism.

[2]  S. Piva,et al.  Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. , 2004, Arthritis and rheumatism.

[3]  David A. Winter,et al.  Biomechanics and Motor Control of Human Movement , 1990 .

[4]  K. Deluzio,et al.  Gender differences exist in osteoarthritic gait. , 2007, Clinical biomechanics.

[5]  M. Pandy,et al.  Muscle, ligament, and joint-contact forces at the knee during walking. , 2005, Medicine and science in sports and exercise.

[6]  Patrick A Costigan,et al.  Mechanical factors relate to pain in knee osteoarthritis. , 2008, Clinical biomechanics.

[7]  T. Andriacchi,et al.  Interaction between active and passive knee stabilizers during level walking , 1991, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[8]  A. Mündermann,et al.  Implications of increased medio-lateral trunk sway for ambulatory mechanics. , 2008, Journal of biomechanics.

[9]  Richard K. Jones,et al.  A new biomechanical model for the functional assessment of knee osteoarthritis. , 2004, The Knee.

[10]  Seungbum Koo,et al.  A Framework for the in Vivo Pathomechanics of Osteoarthritis at the Knee , 2004, Annals of Biomedical Engineering.

[11]  T. Andriacchi,et al.  Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. , 1998, Arthritis and rheumatism.

[12]  R. B. Davis,et al.  A gait analysis data collection and reduction technique , 1991 .

[13]  T. Andriacchi,et al.  Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. , 2005, Arthritis and rheumatism.

[14]  Christopher L. Vaughan,et al.  Dynamics of human gait , 1992 .

[15]  Marcus G Pandy,et al.  Contributions of muscles, ligaments, and the ground‐reaction force to tibiofemoral joint loading during normal gait , 2006, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[16]  Mengtao Guo,et al.  The influence of foot progression angle on the knee adduction moment during walking and stair climbing in pain free individuals with knee osteoarthritis. , 2007, Gait & posture.

[17]  Laura E Thorp,et al.  Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. , 2006, Arthritis and rheumatism.

[18]  T. Andriacchi,et al.  Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. , 2004, Arthritis and rheumatism.

[19]  T. Brown,et al.  Baseline articular contact stress levels predict incident symptomatic knee osteoarthritis development in the MOST cohort , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[20]  T. Miyazaki,et al.  Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis , 2002, Annals of the rheumatic diseases.

[21]  Michael Doherty,et al.  Quadriceps weakness in knee osteoarthritis: the effect on pain and disability , 1998, Annals of the rheumatic diseases.

[22]  J. Kellgren,et al.  Radiological Assessment of Osteo-Arthrosis , 1957, Annals of the rheumatic diseases.

[23]  Benjamin J. Fregly.  Computational Assessment of Combinations of Gait Modifications for Knee Osteoarthritis Rehabilitation , 2008, IEEE Transactions on Biomedical Engineering.

[24]  L. Fried,et al.  Disability in Older Adults: Evidence Regarding Significance, Etiology, and Risk , 1997, Journal of the American Geriatrics Society.

[25]  B. Fregly,et al.  Correlation between the knee adduction torque and medial contact force for a variety of gait patterns , 2007, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[26]  M. Hurley.  Muscle dysfunction and effective rehabilitation of knee osteoarthritis: what we know and what we need to find out. , 2003, Arthritis and rheumatism.

[27]  T. Andriacchi,et al.  The influence of total knee-replacement design on walking and stair-climbing. , 1982, The Journal of bone and joint surgery. American volume.

[28]  Patrick A Costigan,et al.  Role of knee kinematics and kinetics on performance and disability in people with medial compartment knee osteoarthritis. , 2006, Clinical biomechanics.

[29]  Makiko Kouchi,et al.  Validation of the estimation methods for the hip joint center. , 2003 .

[30]  Noriko Yoshimura,et al.  Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study , 2009, Journal of Bone and Mineral Metabolism.

[31]  Donald Salter,et al.  The impact of mechanical stress on the pathophysiology of Osteoarthritis. , 2007 .

[32]  Amir Haim,et al.  Differences in gait patterns, pain, function and quality of life between males and females with knee osteoarthritis: a clinical trial , 2009, BMC musculoskeletal disorders.

[33]  M. Akai,et al.  An outcome measure for Japanese people with knee osteoarthritis. , 2005, The Journal of rheumatology.

[34]  C. Cooper,et al.  Risk factors for knee osteoarthritis in Japanese women: heavy weight, previous joint injuries, and occupational activities. , 2004, The Journal of rheumatology.

[35]  J. Block,et al.  Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis. , 2007, Arthritis and rheumatism.