Changes in the total knee joint moment in patients with medial compartment knee osteoarthritis over 5 years

Asay, Jessica L.; Erhart‐Hledik, Jennifer C.; Andriacchi, Thomas P.

doi:10.1002/jor.23908

Cited by 31 publications

(55 citation statements)

References 37 publications

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“…Importantly, the non‐surgical limb peak KAM increased over the 5 years, while the peak KFM decreased over the same period, suggesting the opposite changes observed in the HTO‐ACLR limb are not simply due to changes over time regardless of surgery. The increase in early stance KAM accompanied by a decrease in the KFM and no change in the rotation moment is somewhat consistent with another longitudinal study in patients with knee OA, suggesting contributions to total joint loading may shift from the sagittal to the frontal plane . How such changes might contribute to changes in measures of OA progression, might be observed over time in aging populations without knee OA, or might be affected by interventions (to either limb) deserve further research.…”

Section: Discussionsupporting

confidence: 85%

“…The increase in early stance KAM accompanied by a decrease in the KFM and no change in the rotation moment is somewhat consistent with another longitudinal study in patients with knee OA, suggesting contributions to total joint loading may shift from the sagittal to the frontal plane. 49 How such changes might contribute to changes in measures of OA progression, might be observed over time in aging populations without knee OA, or might be affected by interventions (to either limb) deserve further research. Similarly, strategies to encourage or prevent potential transition between KFM and KAM dominance should be explored.…”

Section: Discussionmentioning

confidence: 99%

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Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study

Marriott

Birmingham

Pinto

et al. 2018

Journal Orthopaedic Research

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The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening‐wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO‐ACLR). Fifty‐two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [−1.34 %BW × Ht (−1.71, −0.96) and −1.72 %BW × Ht (−1.99, −1.44) for HTO and HTO‐ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [−0.88 %BW × Ht (−1.45, −0.31)] but not in the HTO‐ACLR group [0.03 %BW × Ht (−0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening‐wedge HTO and ACL reconstruction may not experience the same long‐term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study

Marriott

Birmingham

Pinto

et al. 2018

Journal Orthopaedic Research

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“…A vertical ground reaction force threshold of 10 N was used to detect the beginning and the end of the stance phase (heel‐strike and toe‐off). The TJM was calculated during each time point of the stance phase by taking the square root of the sum of the squares of the KFM, KAM, and KRM:

TJM normal = \sqrt{{KFM}^{2} + {KAM}^{2} + {KRM}^{2}}

…”

Section: Methodsmentioning

confidence: 99%

“…The total joint moment (TJM) appears to provide a meaningful metric that captures the influence of each moment component acting at the knee joint by incorporating contributions of the KAM, KFM, and KRM. While the TJM acts externally to the joint, it appears to reflect temporal patterns similar to direct measures of the internal joint contact force, with two peaks occurring in early and late stance during walking.…”

mentioning

confidence: 99%

“…While the TJM acts externally to the joint, it appears to reflect temporal patterns similar to direct measures of the internal joint contact force, with two peaks occurring in early and late stance during walking. In a prospective study of patients with radiographic knee OA, it was shown that the contribution of KFM to the first peak of the TJM decreased and the contribution of KAM increased, while the magnitude of the first peak of the TJM did not change over a 5‐year follow‐up, suggesting that compensatory changes between the KFM and KAM occur over time in OA patients. In patients following ACLR at 2 years post surgery, it was reported that the second TJM peak was lower in the ACLR knee versus the contralateral knee during walking.…”

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confidence: 99%

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Longitudinal Changes in the Total Knee Joint Moment After Anterior Cruciate Ligament Reconstruction Correlate With Cartilage Thickness Changes

Erhart‐Hledik

Chu

Asay

et al. 2019

Journal Orthopaedic Research

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This study investigated associations between changes in the total joint moment (TJM) at the knee and changes in cartilage thickness after anterior cruciate ligament reconstruction (ACLR). Seventeen subjects (five males; age: 29.6 ± 7.3 years) with unilateral ACLR underwent gait analysis and magnetic resonance imaging at baseline (2.2 ± 0.3 years post-ACLR) and at long-term follow-up (7.7 ± 0.7 years post-ACLR). Knee loading was assessed using the TJM, and differences in loading were analyzed using repeated measures analysis of variance. Pearson correlation coefficients assessed associations between changes in TJM and changes in (medial-tolateral) M/L femoral cartilage thickness ratios in the ACLR limb. Bilaterally, there was no significant change in the magnitude of the TJM first peak (TJM1), however, there was a significant increase in the percent contribution of the knee flexion moment (KFM) (p < 0.001) and decrease in the percent contribution of the knee adduction moment (KAM) to TJM1 (p < 0.001). The change in the percent contributions of KFM and KAM to TJM1 were associated with changes in M/L femoral cartilage thickness in the ACLR limb. Specifically, subjects with smaller increases in KFM contribution (R = 0.521, p = 0.032) and smaller decreases in KAM contribution (R = −0.521, p = 0.032) had a reduction in the M/L ratio in the central femoral subregion over the follow-up period, with similar trends in the external femoral subregion. The study results provide new insight into changes in the loading environment at the knee joint prospectively following ACL reconstruction and give evidence that there are modifiable gait metrics that are associated with cartilage changes after ACLR.

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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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Changes in the total knee joint moment in patients with medial compartment knee osteoarthritis over 5 years

Cited by 31 publications

References 37 publications

Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study

Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study

Longitudinal Changes in the Total Knee Joint Moment After Anterior Cruciate Ligament Reconstruction Correlate With Cartilage Thickness Changes

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

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