Relationships between varus–valgus laxity of the severely osteoarthritic knee and gait, instability, clinical performance, and function

Increased varus–valgus laxity has been reported in individuals with knee osteoarthritis (OA) compared to controls. However, the majority of previous investigations may not report truly passive joint laxity, as their tests have been performed on conscious participants who could be guarding against motion with muscle contraction during laxity evaluation. The purpose of this study was to investigate how a measure of passive knee laxity, recorded when the participant is under anesthesia, is related to varus–valgus excursion during gait, clinical measures of performance, perceived instability, and self‐reported function in participants with severe knee OA. We assessed passive varus–valgus knee laxity in 29 participants (30 knees) with severe OA, as they underwent total knee arthroplasty (TKA). Participants also completed gait analysis, clinical assessment of performance (6‐min walk (6 MW), stair climbing test (SCT), isometric knee strength), and self‐reported measures of function (perceived instability, Knee injury, and Osteoarthritis Outcome Score (KOOS) a median of 18 days before the TKA procedure. We observed that greater passive varus–valgus laxity was associated with greater varus–valgus excursion during gait (R2 = 0.34, p = 0.002). Significant associations were also observed between greater laxity and greater isometric knee extension strength (p = 0.014), farther 6 MW distance (p = 0.033) and shorter SCT time (p = 0.046). No relationship was observed between passive varus–valgus laxity and isometric knee flexion strength, perceived instability, or any KOOS subscale. The conflicting associations between laxity, frontal excursion during gait, and functional performance suggest a complex relationship between laxity and knee cartilage health, clinical performance, and self‐reported function that merits further study. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1644–1652, 2017.

[1]  Jennifer M. Hootman,et al.  Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation — United States, 2010–2012 , 2013, MMWR. Morbidity and mortality weekly report.

[2]  T. Andriacchi,et al.  Adduction moment increases with age in healthy obese individuals , 2013, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[3]  Robert A Siston,et al.  Is There a Gold Standard for TKA Tibial Component Rotational Alignment? , 2013, Clinical orthopaedics and related research.

[4]  K. Manal,et al.  Knee joint loading during gait in healthy controls and individuals with knee osteoarthritis. , 2013, Osteoarthritis and cartilage.

[5]  Erin E Hutter,et al.  Design and cadaveric validation of a novel device to quantify knee stability during total knee arthroplasty. , 2012, Journal of biomechanical engineering.

[6]  W. Lems,et al.  Proprioception, laxity, muscle strength and activity limitations in early symptomatic knee osteoarthritis: results from the CHECK cohort. , 2012, Journal of rehabilitation medicine.

[7]  D. Knol,et al.  Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort , 2012, Clinical Rheumatology.

[8]  Sara R Piva,et al.  Interrater reliability and validity of the stair ascend/descend test in subjects with total knee arthroplasty. , 2010, Archives of physical medicine and rehabilitation.

[9]  K. Rudolph,et al.  Instability, Laxity, and Physical Function in Patients With Medial Knee Osteoarthritis , 2008, Physical Therapy.

[10]  Annegret Mündermann,et al.  In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[11]  K. Rudolph,et al.  Muscle stabilization strategies in people with medial knee osteoarthritis: The effect of instability , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[12]  R. Hinman,et al.  Varus malalignment and its association with impairments and functional limitations in medial knee osteoarthritis. , 2008, Arthritis and rheumatism.

[13]  D. Knol,et al.  Knee varus-valgus motion during gait--a measure of joint stability in patients with osteoarthritis? , 2008, Osteoarthritis and cartilage.

[14]  S. Toyabe,et al.  Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty , 2009, International Orthopaedics.

[15]  M. Lewek,et al.  Age-Related Changes in Strength, Joint Laxity, and Walking Patterns: Are They Related to Knee Osteoarthritis? , 2007, Physical Therapy.

[16]  K. Rudolph,et al.  Influences on knee movement strategies during walking in persons with medial knee osteoarthritis. , 2007, Arthritis and rheumatism.

[17]  D. Knol,et al.  Joint laxity and the relationship between muscle strength and functional ability in patients with osteoarthritis of the knee. , 2006, Arthritis and rheumatism.

[18]  Scott L Delp,et al.  Intraoperative passive kinematics of osteoarthritic knees before and after total knee arthroplasty , 2006, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[19]  L B Mokkink,et al.  Performance-based methods for measuring the physical function of patients with osteoarthritis of the hip or knee: a systematic review of measurement properties. , 2006, Rheumatology.

[20]  Aurelio Cappozzo,et al.  An optimized protocol for hip joint centre determination using the functional method. , 2006, Journal of biomechanics.

[21]  Scott L Delp,et al.  Evaluation of a new algorithm to determine the hip joint center. , 2006, Journal of biomechanics.

[22]  Tanja Popovic,et al.  Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation--United States, 2003-2005. , 2006, MMWR. Morbidity and mortality weekly report.

[23]  Karl Swedberg,et al.  Six minute walk test. , 2005, European heart journal.

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

[25]  M. Lewek,et al.  Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis. , 2004, Osteoarthritis and cartilage.

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

[27]  M. Lewek,et al.  Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[28]  Yi-Chung Pai,et al.  Physical functioning over three years in knee osteoarthritis: role of psychosocial, local mechanical, and neuromuscular factors. , 2003, Arthritis and rheumatism.

[29]  P. Enright,et al.  The 6‐min Walk Test: A Quick Measure of Functional Status in Elderly Adults. , 2003, Chest.

[30]  T. Miyazaki,et al.  Joint Proprioception Before and After Total Knee Arthroplasty , 2002, Clinical orthopaedics and related research.

[31]  T P Andriacchi,et al.  Effect of knee pain on joint loading in patients with osteoarthritis. , 1999, Current opinion in rheumatology.

[32]  L. Sharma,et al.  Laxity in healthy and osteoarthritic knees. , 1999, Arthritis and rheumatism.

[33]  Y. Pai,et al.  Does laxity alter the relationship between strength and physical function in knee osteoarthritis? , 1999, Arthritis and rheumatism.

[34]  T P Andriacchi,et al.  A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. , 1998, Journal of biomechanical engineering.

[35]  Freddie H. Fu,et al.  Development of a Patient-Reported Measure of Function of the Knee* , 1998, The Journal of bone and joint surgery. American volume.

[36]  B. Beynnon,et al.  Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. , 1998, The Journal of orthopaedic and sports physical therapy.

[37]  Y. Pai,et al.  Effect of age and osteoarthritis on knee proprioception. , 1997, Arthritis and rheumatism.

[38]  M. Hurley,et al.  Sensorimotor changes and functional performance in patients with knee osteoarthritis , 1997, Annals of the rheumatic diseases.

[39]  W. Applegate,et al.  A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). , 1997, JAMA.

[40]  W. Ettinger,et al.  Assessing performance-related disability in patients with knee osteoarthritis. , 1995, Osteoarthritis and cartilage.

[41]  C M Wise,et al.  Osteoarthritis of the knee: effects on gait, strength, and flexibility. , 1992, Archives of physical medicine and rehabilitation.

[42]  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.

[43]  K. Markolf,et al.  Stiffness and laxity of the knee--the contributions of the supporting structures. A quantitative in vitro study. , 1976, The Journal of bone and joint surgery. American volume.

[44]  D. van Nostrand,et al.  Preresectional evaluation of risk from pneumonectomy. , 1968, Surgery, gynecology & obstetrics.

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