Gait Mechanics Influence Healthy Cartilage Morphology and Osteoarthritis of the Knee

Abstract

The response of healthy and diseased cartilage of the knee to the mechanics of walking is examined, with the goal of providing insight into the relationship between the kinematics and kinetics of the knee during walking and the maintenance of cartilage health. The combination of information from three-dimensional thickness models of cartilage derived from magnetic resonance imaging and the analysis of the interaction between load at the knee and kinematic changes during walking associated with loss of the anterior cruciate ligament demonstrated the importance of considering walking mechanics as an important factor in the initiation and progression of osteoarthritis. In particular, this material suggests that knee cartilage becomes conditioned to loading and to the large number of repetitive cycles of loading that occur during walking and that healthy cartilage homeostasis is maintained as long as there are no changes to the normal patterns of locomotion, the structure of the knee joint, or cartilage biology. Thus, there is the potential for a degenerative pathway to be initiated when a condition such as anterior cruciate ligament injury causes the repetitive loading during walking to shift to a new location. The sensitivity of cartilage to the kinematic changes is illustrated with the anterior cruciate ligament-deficient knee and the regional variations in cartilage morphology. The material presented here supports the conclusion that individual variations in the range of loading and kinematics at the knee during walking can have a profound influence on the initiation and progression of osteoarthritis of the knee.

Instability Dependency of Osteoarthritis Development in a Rabbit Model of Graded Anterior Cruciate Ligament Transection

“…However, as suggested by Tochigi et al 27 , even small instability events can cause supraphysiological high-rate cartilage loading (i.e., the socalled microinstability concept), and the cumulative effects of such microinstability events may lead to gradual cartilage degeneration. In addition, as demonstrated by Andriacchi et al 28 , Fig. 6 Correlations of global cartilage degeneration in the medial compartment with instability in the twenty knees that had partial transection of the ACL (including both eight-week and sixteen-week animals), as assessed by means of anterior drawer test stiffness (left) and of neutral zone length (right).…”

Kinematic adaptations to a variable stiffness shoe: Mechanisms for reducing joint loading

“…One important marker and target for non-invasive intervention is the first peak of the external knee adduction moment in walking (Miyazaki et al, 2002). It is a surrogate marker of the relative load on the medial compartment (Schipplein and Andriacchi, 1991) and has been correlated with OA radiographic severity, rate of disease progression and severity of disease symptoms (Andriacchi et al, 2004;Andriacchi et al, 2009;Andriacchi and Mundermann, 2006;Astephen et al, 2007;Baliunas et al, 2002;Sharma et al, 1998).…”

Variations in the three‐dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction

“…[4][5][6] Observations of alterations in tibiofemoral kinematics following ACL reconstruction [7][8][9] have lead some authors to suggest that restoration of normal kinematics may play an important role in preventing premature OA in this population. [10][11][12][13] Interestingly, several recent cadaveric [14][15][16] and in vivo 17,18 studies have linked altered joint mechanics to reconstruction techniques that fail to place the graft within the footprint of the native ACL, thereby changing the orientation and corresponding biomechanical function of the ACL. Nonetheless, recent studies suggest that placement of grafts in a nonanatomic position is a frequent problem, with grafts commonly placed in a relatively vertical orientation in both the sagittal and coronal planes.…”