Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait

Heiden, Tamika; Lloyd, David G.; Ackland, Tim

doi:10.1016/j.clinbiomech.2009.08.005

Cited by 221 publications

(190 citation statements)

References 52 publications

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“…Other structures are also involved, and clinical investigation often reveals laxity of the knee joint (Lewek et al, 2004) and/or quadriceps weakness (Hortobágyi et al, 2005). Patients with knee pain (Heiden et al, 2009), or effusion (Torry et al, 2000), may alter their muscle activity, as do patients who feel unstable during gait (Schmitt and Rudolph, 2008). Over the last decade, muscle activation patterns in gait have drawn considerable attention in the knee osteoarthritis literature.…”

Section: Introductionmentioning

confidence: 99%

“…Over the last decade, muscle activation patterns in gait have drawn considerable attention in the knee osteoarthritis literature. It was often reported that patients co-contract longer, co-contract more, or have higher muscle activity during walking than controls (e.g., Benedetti et al, 1999;Briem et al, 2007;Childs et al, 2004;Heiden et al, 2009;Hortobágyi et al, 2005;Hubley-Kozey et al, 2006;Lewek et al, 2003;Rudolph et al, 2001;Schmitt and Rudolph, 2007;Zeni et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

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Determinants of co-contraction during walking before and after arthroplasty for knee osteoarthritis

Fallah-Yakhdani¹,

Bafghi²,

Meijer³

et al. 2012

Clinical Biomechanics

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Background: Knee osteoarthritis patients co-contract in knee-related muscle pairs during walking. The determinants of this co-contraction remain insufficiently clear. Methods: A heterogeneous group of 14 patients was measured before and one year after knee arthroplasty, and compared to 12 healthy peers and 15 young subjects, measured once. Participants walked on a treadmill at several imposed speeds. Bilateral activity of six muscles was registered electromyographically, and cocontraction time was calculated as percentage of stride cycle time. Local dynamic stability and variability of sagittal plane knee movements were determined. The surgeon's assessment of alignment was used. Preoperatively, multivariate regressions on co-contraction time were used to identify determinants of cocontraction. Post-operatively it was assessed if predictor variables had changed in the same direction as co-contraction time. Findings: Patients co-contracted longer than controls, but post-operatively, differences with the healthy peers were no longer significant. Varus alignment predicted co-contraction time. No patient had post-operative varus alignment. The patients' unaffected legs were more unstable, and instability predicted co-contraction time in both legs. Post-operatively, stability normalised. Longer unaffected side co-contraction time was associated with reduced affected side kinematic variability. Post-operatively, kinematic variability had further decreased. Interpretations: Varus alignment and instability are determinants of co-contraction. The benefits of cocontraction in varus alignment require further study. Co-contraction probably increases local dynamic stability, which does not necessarily decrease the risk of falling. Unaffected side co-contraction contributed to decreasing affected side variability, but other mechanisms than co-contraction may also have played a role in decreasing variability.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Determinants of co-contraction during walking before and after arthroplasty for knee osteoarthritis

Fallah-Yakhdani¹,

Bafghi²,

Meijer³

et al. 2012

Clinical Biomechanics

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“…All subjective measurements were correlated (|r| C 0.54) with one another (Table 3), as were most of the objective measurements (|r| C 0.56) except for the peak knee adduction moment which did not correlate with any variable. The lack of correlation of the peak adduction moment to VAS knee pain and other variables was puzzling as it was contrary to the expected outcomes based on several previous reports [29,30,36,37]. However, other researchers also have observed a lack of correlation of knee adduction moment with knee pain, and other variables pertinent in knee OA.…”

Section: Discussionmentioning

confidence: 62%

“…However, conflicting reports exist related to knee adduction moment. Heiden et al reported that larger adduction moment was correlated with lower self-perceived knee pain and other OA symptoms [29], whereas Maly et al observed no correlation between knee adduction moment and knee OA pain [47]. Also, a lack of correlation between knee adduction moment and limb varus/ valgus alignment has been reported [57,73,75].…”

Section: Discussionmentioning

confidence: 99%

“…Knee function may be assessed subjectively using validated questionnaires such as the KOOS [60] and objectively, using 3-D gait analysis that yields several kinematic and kinetic variables of dynamic knee function [26,49,56]. In medial knee OA with a varus malalignment, which is the most common presentation, the knee adduction angle and (externally referenced) adduction moment during gait are considered important [6,11,21,29]. The knee adduction moment is considered a surrogate of medial compartment load [1], and has been correlated with pain in medial knee OA [71], disease severity [66], and rate of disease progression [50].…”

Section: Introductionmentioning

confidence: 99%

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Are Joint Structure and Function Related to Medial Knee OA Pain? A Pilot Study

Zifchock

Kirane

Hillstrom

2011

Clinical Orthopaedics &Amp; Related Research

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Background Although the severity of knee osteoarthritis (OA) usually is assessed using different measures of joint structure, function, and pain, the relationships between these measures are unclear. Purpose Therefore, we: (1) examined the relationships between the measures of knee structure (flexion-extension range of motion, radiographic tibiofemoral angle, and medial joint space), function (Knee Osteoarthritis Outcome Scores [KOOS], peak adduction angle, and moment), and pain (visual analog scale [VAS]); and (2) identified variables that best predicted knee pain. Methods We assessed 15 patients with medial knee OA using VAS pain, KOOS questionnaire, 3-D gait analysis, and radiographic examination. Parameter relationships were assessed using Pearson correlation, and variables most predictive of knee pain were determined using a stepwise multiple regression. Results Subjective measurements correlated (|r| C 0.54) with one another, as did most of the objective measurements (|r| C 0.56) except for adduction moment which did not correlate with any variable. All variables correlated (|r| [ 0.54) with VAS knee pain except peak adduction moment. Medial joint space and peak adduction angle best predicted knee pain, accounting for approximately threequarters of the model variance (r 2 = 0.73).

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Individuals with severe knee osteoarthritis (OA) exhibit altered proximal walking mechanics compared with individuals with less severe OA and those without knee pain

Hunt¹,

Wrigley²,

Hinman³

et al. 2010

Arthritis Care & Research

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Objective. To examine hip, pelvis, and trunk walking biomechanics in individuals with medial compartment knee osteoarthritis (OA) of varying radiographic disease severities and others without knee pain. Methods. Hip, pelvis, and trunk kinematics and hip kinetics were assessed in 75 individuals with radiographically confirmed OA and 20 asymptomatic individuals. Differences in peak hip adduction and abduction angles, the amount of contralateral pelvic drop, and peak lateral trunk lean measured by 3-dimensional gait analysis were examined using analyses of variance. Peak external hip abduction and adduction moments were compared using analyses of covariance, with gait speed as a covariate. Results. Those with severe OA disease exhibited significantly less peak hip adduction (5.0°), but more ipsilateral trunk lean toward the study extremity (5.0°) than all other groups (P < 0.001). Those in the severe (1.1°) and asymptomatic (0.9°) groups also exhibited significantly less lateral trunk lean toward the non-study extremity (P ‫؍‬ 0.004). No significant differences in hip joint moments or contralateral pelvic drop were observed between the groups (P > 0.02). Conclusion. Gait changes at the hip and trunk were evident across the groups based on radiographic disease severity and compared with those without knee pain. Although not conclusive from this cross-sectional study design, the results provide initial evidence to support increased lateral trunk lean as being a compensatory response to the disease.

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Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait

Cited by 221 publications

References 52 publications

Determinants of co-contraction during walking before and after arthroplasty for knee osteoarthritis

Determinants of co-contraction during walking before and after arthroplasty for knee osteoarthritis

Are Joint Structure and Function Related to Medial Knee OA Pain? A Pilot Study

Individuals with severe knee osteoarthritis (OA) exhibit altered proximal walking mechanics compared with individuals with less severe OA and those without knee pain

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