Are biomechanics during gait associated with the structural disease onset and progression of lower limb osteoarthritis? A systematic review and meta-analysis

D'Souza, N.; Charlton, Jesse M.; Grayson, Jane; Kobayashi, Sarah; Hutchison, Laura; Hunt, Michael A.; Simić, Milena

doi:10.1016/j.joca.2021.10.010

Cited by 32 publications

(36 citation statements)

References 51 publications

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“…Changed kinematics in PCL insufficient knees could present potential risk factors for progressive cartilage degeneration 19 . Future work should therefore include the analysis of progressive changes in knee joint kinematics after PCL insufficiency and PCL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Although a high degree of translational laxity has been shown in PCL insufficient subjects during passive conditions, a reduced feeling of instability has been reported by patients during active conditions, possibly related to loading dependent kinematical changes in the affected knee 18 . Such kinematical changes could be however related to muscular compensation of excessive motion or to additional risk factors leading to further cartilage degeneration 18 , 19 .…”

Section: Introductionmentioning

confidence: 99%

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PCL insufficient patients with increased translational and rotational passive knee joint laxity have no increased range of anterior–posterior and rotational tibiofemoral motion during level walking

Oehme

Moewis

Boeth

et al. 2022

Sci Rep

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Passive translational tibiofemoral laxity has been extensively examined in posterior cruciate ligament (PCL) insufficient patients and belongs to the standard clinical assessment. However, objective measurements of passive rotational knee laxity, as well as range of tibiofemoral motion during active movements, are both not well understood. None of these are currently quantified in clinical evaluations of patients with PCL insufficiency. The objective of this study was to quantify passive translational and rotational knee laxity as well as range of anterior–posterior and rotational tibiofemoral motion during level walking in a PCL insufficient patient cohort as a basis for any later clinical evaluation and therapy. The laxity of 9 patient knees with isolated PCL insufficiency or additionally posterolateral corner (PLC) insufficiency (8 males, 1 female, age 36.78 ± 7.46 years) were analysed and compared to the contralateral (CL) knees. A rotometer device with a C-arm fluoroscope was used to assess the passive tibiofemoral rotational laxity while stress radiography was used to evaluate passive translational tibiofemoral laxity. Functional gait analysis was used to examine the range of anterior–posterior and rotational tibiofemoral motion during level walking. Passive translational laxity was significantly increased in PCL insufficient knees in comparison to the CL sides (15.5 ± 5.9 mm vs. 3.7 ± 1.9 mm, p < 0.01). Also, passive rotational laxity was significantly higher compared to the CL knees (26.1 ± 8.2° vs. 20.6 ± 5.6° at 90° knee flexion, p < 0.01; 19.0 ± 6.9° vs. 15.5 ± 5.9° at 60° knee flexion, p = 0.04). No significant differences were observed for the rotational (16.3 ± 3.7° vs. 15.2 ± 3.6°, p = 0.43) and translational (17.0 ± 5.4 mm vs. 16.1 ± 2.8 mm, p = 0.55) range of anterior–posterior and rotational tibiofemoral motion during level walking conditions for PCL insufficient knees compared to CL knees respectively. The present study illustrates that patients with PCL insufficiency show a substantial increased passive tibiofemoral laxity, not only in tibiofemoral translation but also in tibiofemoral rotation. Our data indicate that this increased passive multiplanar knee joint laxity can be widely compensated during level walking. Further studies should investigate progressive changes in knee joint laxity and kinematics post PCL injury and reconstruction to judge the individual need for therapy and effects of physiotherapy such as quadriceps force training on gait patterns in PCL insufficient patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

PCL insufficient patients with increased translational and rotational passive knee joint laxity have no increased range of anterior–posterior and rotational tibiofemoral motion during level walking

Oehme

Moewis

Boeth

et al. 2022

Sci Rep

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“…Prior longitudinal studies of gait and OA typically examined knee-specific loading (e.g., knee adduction moment) rather than GRFs, often with samples of 15 to 300 knees. [5] Correspondingly, few addressed clinical and demographic confounders, incorporated physical activity predictors, or used cross-validation to examine performance in independent test sets. Further, many of these studies were conducted in samples with established OA (KLG ≥ 2), limiting their potential to identify those at risk of progression early in the disease process or identify targets for early intervention.…”

Section: Discussionmentioning

confidence: 99%

Section: Model Performancementioning

confidence: 99%

“…Mechanical loading on the joint is one of the only modifiable risk factors for knee OA [4] and can be manipulated through gait and/or physical activity interventions. While prior research has identified key gait features associated with medial tibiofemoral knee OA progression, [5] these have typically been examined in isolation, in small samples, and/or without accounting for other known clinical/demographic risk factors. Importantly, little is known about gait and physical activity predictors of progression in individuals early in the disease process.…”

Section: Introductionmentioning

confidence: 99%

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Gait, physical activity, and tibiofemoral cartilage damage: A longitudinal machine learning analysis in the Multicenter Osteoarthritis Study

Costello

Felson

Jafarzadeh

et al. 2022

Preprint

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Objective: To 1) develop and evaluate a machine learning model incorporating gait and physical activity to predict medial tibiofemoral cartilage worsening over two years in individuals without or with early knee osteoarthritis and 2) identify influential predictors in the model and quantify their effect on cartilage worsening. Design: An ensemble machine learning model was developed to predict worsened cartilage MRI Osteoarthritis Knee Score at 2-year follow-up from gait, physical activity, clinical and demographic data from the Multicenter Osteoarthritis Study. Model performance was evaluated with Area Under the Curve (AUC) in repeated cross-validations. The top 10 influential predictors of the outcome across 100 held-out test sets were identified by a variable importance measure statistic, and their marginal effect on the outcome was quantified by g-computation. Results: Of 947 legs included in the analysis, 14% experienced medial cartilage worsening over two years. The median (2.5th-97.5th percentile) AUC across the 100 held-out test sets was 0.73 (0.64-0.80). Presence of baseline cartilage damage, higher Kellgren-Lawrence grade, greater pain during walking, and higher lateral ground reaction force impulse were associated with greater risk of cartilage worsening. Conclusions: An ensemble machine learning approach incorporating gait, physical activity, and clinical/demographic features showed good performance for predicting cartilage worsening over two years. While identifying potential intervention targets from the machine learning model is challenging, these results suggest that addressing high lateral ground reaction force impulse should be investigated further as a potential target to reduce medial tibiofemoral cartilage worsening in persons without or with early knee osteoarthritis.

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Relationship Between Knee Biomechanics and Pain in People With Knee Osteoarthritis: A Systematic Review and Meta‐Analysis

Hutchison

Grayson

Hiller

et al. 2022

Arthritis Care & Research

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Objective Our primary aim was to determine the cross‐sectional relationship between knee biomechanics during gait and pain in people with medial knee osteoarthritis. Our secondary aim was to evaluate differences in knee biomechanics between symptomatic and asymptomatic participants with medial knee osteoarthritis. Methods Four online databases were searched from inception to July 2021. Eligible studies included people with medial/nonspecific knee osteoarthritis and a reported relationship between knee biomechanics during gait and pain or biomechanics of symptomatic and asymptomatic participants. Two reviewers independently extracted data and evaluated risk of bias. Random‐effects meta‐analyses were performed when three or more studies reported the same biomechanical variable for pooling (knee adduction moment [KAM], KAM impulse, varus thrust, and peak knee flexion moment [KFM]). Results Forty studies were included. Methodological quality ranged from 4 to 9/10. Forty‐seven unique biomechanical variables were reported. For the KAM, there was no correlation with pain for peak values pooled (early stance and overall) (r = 0.00, 95% confidence interval [95% CI]: −0.12, 0.11, k = 16), a small negative correlation for early stance peak alone (r = −0.09, 95% CI −0.18, −0.002, k = 12), and a medium positive correlation for the overall peak during stance (r = 0.30, 95% CI 0.17, 0.42, k = 4). Metaregression identified that body mass index moderated the peak KAM–pain relationship (P < 0.001). KAM impulse had a small positive correlation with pain (r = 0.23, 95% CI 0.04, 0.40, k = 5), and people with varus thrust had 3.84 greater odds of reporting pain compared with people without (95% CI 1.72, 8.53, k = 3). Meta‐analyses for the peak KFM and pain correlation and secondary aim were nonsignificant. Conclusion Some knee gait biomechanics were associated with pain in this cohort. Longitudinal studies are required to determine causality.

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Are biomechanics during gait associated with the structural disease onset and progression of lower limb osteoarthritis? A systematic review and meta-analysis

Cited by 32 publications

References 51 publications

PCL insufficient patients with increased translational and rotational passive knee joint laxity have no increased range of anterior–posterior and rotational tibiofemoral motion during level walking

PCL insufficient patients with increased translational and rotational passive knee joint laxity have no increased range of anterior–posterior and rotational tibiofemoral motion during level walking

Gait, physical activity, and tibiofemoral cartilage damage: A longitudinal machine learning analysis in the Multicenter Osteoarthritis Study

Relationship Between Knee Biomechanics and Pain in People With Knee Osteoarthritis: A Systematic Review and Meta‐Analysis

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