Sagittal plane joint loading is related to knee flexion in osteoarthritic gait.

BACKGROUND High mechanical loading has been consistently linked with medial tibiofemoral osteoarthritis, and is considered to play a central role in the pathogenesis of the disease. Evidence from healthy adults indicates that knee flexion kinematics may influence knee load. The purpose of this study therefore, was to investigate the association between knee flexion kinematics and indicators of joint loading during walking (peak moments and vertical ground reaction force), in individuals with medial tibiofemoral osteoarthritis. METHODS In this cross-sectional study, 89 participants with painful medial tibiofemoral osteoarthritis completed three-dimensional walking gait analysis to measure stance phase ground reaction forces, knee joint moments, and knee flexion kinematics. FINDINGS In stepwise regression, greater knee flexion excursion was associated with higher peak vertical ground reaction force, accounting for 10% of its variance (B=0.62 [95% CI 0.34, 0.89], P<0.001). Greater peak knee flexion was associated with a higher flexion moment, accounting for 44% of its variance (B=0.12 [95% CI 0.09, 0.15], P<0.001). No association was found between the knee adduction moment and knee flexion kinematics during walking. INTERPRETATION Our data suggest that greater knee flexion is associated with higher joint loads in the sagittal plane (i.e. a higher peak knee flexion moment). However, knee flexion kinematics were not associated with the knee adduction moment - a proxy measure of medial compartment knee load. Thus, high knee flexion should be considered an undesirable gait characteristic with respect to knee load in individuals with medial tibiofemoral osteoarthritis.

[1]  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.

[2]  Jeffrey A. Reinbolt,et al.  From the Selectedworks of Jeffrey A. Reinbolt Design of Patient-specific Gait Modifications for Knee Osteoarthritis Rehabilitation Design of Patient-specific Gait Modifications for Knee Osteoarthritis Rehabilitation , 2022 .

[3]  D. Lloyd,et al.  Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. , 2009, Clinical biomechanics.

[4]  Thomas R Jenkyn,et al.  Radiographic Measures of Knee Alignment in Patients with varus Gonarthrosis , 2007, The American journal of sports medicine.

[5]  A. Jones,et al.  Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital. , 1993, Annals of the rheumatic diseases.

[6]  M. Hunt,et al.  Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis. , 2006, Journal of Biomechanics.

[7]  F. Cicuttini,et al.  Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis , 2011, Annals of the rheumatic diseases.

[8]  J. Higginson,et al.  Differences in gait parameters between healthy subjects and persons with moderate and severe knee osteoarthritis: a result of altered walking speed? , 2009, Clinical biomechanics.

[9]  M. Andrews,et al.  Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: A critical analysis of the reliability of gait analysis data , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  Jim Lewsey,et al.  Medical Statistics: A Guide to Data Analysis and Critical Appraisal , 2015 .

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

[12]  Subashan Perera,et al.  Is Timed Up and Go Better Than Gait Speed in Predicting Health, Function, and Falls in Older Adults? , 2011, Journal of the American Geriatrics Society.

[13]  M. Hunt,et al.  Hip muscle weakness in individuals with medial knee osteoarthritis , 2010, Arthritis care & research.

[14]  D. Lloyd,et al.  Pre‐surgery knee joint loading patterns during walking predict the presence and severity of anterior knee pain after total knee arthroplasty , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[15]  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.

[16]  J. Riskowski,et al.  Gait and neuromuscular adaptations after using a feedback-based gait monitoring knee brace. , 2010, Gait & posture.

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

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

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

[20]  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.

[21]  T. Hortobágyi,et al.  Aberrations in the control of quadriceps muscle force in patients with knee osteoarthritis. , 2004, Arthritis and rheumatism.

[22]  Thomas R Jenkyn,et al.  Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: a tri-planar kinetic mechanism. , 2008, Journal of biomechanics.

[23]  T. Vail,et al.  A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. , 2005, Arthritis and rheumatism.

[24]  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.

[25]  T. Derrick.  The effects of knee contact angle on impact forces and accelerations. , 2004, Medicine and science in sports and exercise.

[26]  T V Wrigley,et al.  Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. , 2010, Osteoarthritis and cartilage.

[27]  S. Dixon,et al.  Knee joint stiffness during walking in knee osteoarthritis , 2010, Arthritis care & research.

[28]  Jill L. McNitt-Gray,et al.  Landing Strategies Used by Gymnasts on Different Surfaces , 1994 .

[29]  M. Hunt,et al.  Lateral trunk lean explains variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis. , 2008, Osteoarthritis and cartilage.

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

[31]  E S Grood,et al.  A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. , 1983, Journal of biomechanical engineering.

[32]  B. Fregly,et al.  Effective gait patterns for offloading the medial compartment of the knee , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[33]  Belinda Barton,et al.  Medical Statistics: A Guide to SPSS, Data Analysis and Critical Appraisal , 2005 .

[34]  Reed Ferber,et al.  Biomechanical Deviations During Level Walking Associated With Knee Osteoarthritis: A Systematic Review and Meta‐Analysis , 2013, Arthritis care & research.

[35]  Jill L. McNitt-Gray,et al.  Landing Strategy Adjustments Made by Female Gymnasts in Response to Drop Height and Mat Composition , 1993 .

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

[37]  J. D. Childs,et al.  Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis. , 2004, Clinical biomechanics.

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

[39]  M. Wada,et al.  Relationships among bone mineral densities, static alignment and dynamic load in patients with medial compartment knee osteoarthritis. , 2001, Rheumatology.

[40]  Michael A Hunt,et al.  Gait modification strategies for altering medial knee joint load: A systematic review , 2011, Arthritis care & research.

[41]  T. Andriacchi,et al.  The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[42]  John Scholz,et al.  Stride-to-stride variability of knee motion in patients with knee osteoarthritis. , 2006, Gait & posture.

[43]  J. L. Astephen,et al.  Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[44]  P. Devita,et al.  Effect of landing stiffness on joint kinetics and energetics in the lower extremity. , 1992, Medicine and science in sports and exercise.