Baseline knee adduction and flexion moments during walking are both associated with 5 year cartilage changes in patients with medial knee osteoarthritis

Abstract

Objective To test the hypothesis that knee cartilage changes over five years are associated with baseline peak knee adduction moment (KAM) and peak knee flexion moment (KFM) during early stance. Design Baseline KAM and KFM were measured in sixteen subjects with medial knee OA. Regional changes in cartilage thickness and changes in medial-to-lateral thickness ratio were quantified using magnetic resonance imaging at baseline and again after five years. Multiple regression was used to determine whether baseline measures of KAM and KFM were associated with cartilage changes over five years. Associations with baseline pain score, Kellgren-Lawrence grade, walking speed, age, gender, and body mass index were tested one-by-one in the presence of KAM and KFM. Results Changes over five years in femoral medial-to-lateral thickness ratio were associated with baseline KAM, KFM, and pain score (R2=0.60, p=0.010), and most significantly with KAM (R2=0.33, p=0.019). Changes in tibial medial-to-lateral thickness ratio were associated with baseline KAM, KFM, and walking speed (R2=0.49, p=0.039), with KFM driving this association (R2=0.40, p=0.009). Changes in medial tibial thickness were associated with baseline KAM, KFM, and walking speed (R2=0.49, p=0.041); KFM also drove this association (R2=0.42, p=0.006). Conclusions The findings that the KAM has a greater influence on femoral cartilage change and the KFM has a greater influence on tibial cartilage change provide new insight into the tibiofemoral variations in cartilage changes associated with walking kinetics. These results suggest that both KAM and KFM should be considered when designing disease interventions as well as when assessing the risk for OA progression.

Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations?

“…Varus alignment is associated with a greater risk of medial knee OA and valgus alignment is associated with a greater risk of lateral knee OA [20,46]. During walking, the loading in the frontal plane and sagittal plane has been shown to be related to greater risk of onset and progression of knee OA [9,13,31,39]. However, it is not known if there are differences in static and dynamic measures of knee loading that are present between men and women in healthy and OA populations that could be related to greater prevalence of knee OA in women.…”

The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis

“…The EKAM and KAAI have been used as surrogates for medial knee load , Sharma, Hurwitz, 1998, Weidenhielm et al , 1994, Zhao, Banks, 2007 as well as associated with disease progression (Bennell, Bowles, 2011, Chehab, Favre, 2014, Sharma, Hurwitz, 1998 and severity (Kean et al , 2012) in patients with KOA. For this reason, it was not surprising to find a greater EKAM and KAAI in the KOA group since we included only medial KOA subjects, confirming the same findings found by previous studies (Baliunas, Hurwitz, 2002, Hurwitz, Ryals, 2000, Lewek, Rudolph, 2004, Miyazaki, Wada, 2002, Sharma, Hurwitz, 1998, Weidenhielm, Svensson, 1994.…”

“…For instance, a reduction in EKAM can be associated with an increased knee flexion moment (KFM), which is also detrimental to the knee cartilage (Chehab et al , 2014). Although an increased KFM may affect both knee compartments, it has an important contribution to understanding the medial knee load (Manal et al , 2015) as it is responsible for progression of the disease in specific regions of the medial compartment (Chehab, Favre, 2014). In addition, knee adduction angular impulse (KAAI) has been considered as another important measure of medial knee compartment.…”

“…Considering that knee joint loading is one of the main factors related to the onset and progression of the disease (Baliunas, Hurwitz, 2002, Chang et al , 2015, Chehab, Favre, 2014, Felson, 2013, the combination of knee joint moments and muscle co-activation would be an approach to better understand the behaviour of knee joint load (Winby, Gerus, 2013, Winby, Lloyd, 2009). On the one hand, EKAM, KFM and KAAI are well established variables for measuring knee loading, mainly on the medial knee compartment.…”

Mechanisms underpinning the peak knee flexion moment increase over 2-years following arthroscopic partial meniscectomy

“…The peak KFM increased by approximately 13% over time, such that the peak KFM was 6-11% higher during walking in APM patients compared to healthy controls 2 years later (Hall et al, 2013). Furthermore, a higher KFM during gait has also recently been associated with medial tibial cartilage (Chehab et al, 2014) and patellofemoral joint (Teng et al, 2014) deterioration.…”