Mechanical loads at the knee joint during deep flexion

Nagura, Takeo; Dyrby, Chris O.; Alexander, Eugene J.; Andriacchi, Thomas P.

doi:10.1016/s0736-0266(01)00178-4

Cited by 202 publications

(133 citation statements)

References 28 publications

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“…This disproportionate medial transmission of load results from an adduction moment (18) and reflects the magnitude of intrinsic compressive load on the medial compartment (19). Although the adduction moment in a deep squat may be less than that experienced during walking, the adduction moment remains predominant (20) and likely explains the predilection for OA in the medial compartment in Chinese men.…”

Section: Discussionmentioning

confidence: 99%

“…This large load is applied over a smaller contact area, since the tibiofemoral contact area decreases by about half in deep flexion (27). Others also demonstrated that the tibiofemoral adduction moments generated from deep squatting are significantly larger than those from walking or stair climbing (20). All these might explain why the relationship of squatting at age 25 with the prevalence of tibiofemoral OA is stronger than that with patellofemoral OA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: The Beijing Osteoarthritis Study

Hunter¹,

Nevitt²,

Xu³

et al. 2004

Arthritis & Rheumatism

120

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Objective. To examine the association between squatting, a common daily posture in China, and the prevalence of radiographic osteoarthritis (OA) in different knee compartments among Chinese subjects from Beijing, and to estimate how much of the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in Framingham, Massachusetts is accounted for by the impact of squatting.Methods. We recruited a random sample of Beijing residents age >60 years. Subjects answered questions on joint symptoms, and knee radiographs were obtained. Subjects were also asked to recall the average amount of time spent squatting each day at age 25 years. Radiographic films (weight-bearing anteroposterior and skyline views) were read for Kellgren/Lawrence (K/L) grade and individual radiographic features. Medial disease was defined when radiographs showed a K/L grade of >2 at the tibiofemoral joint and a medial joint space narrowing score of >1, and lateral disease was assessed in a comparable manner in the lateral compartments. We examined the association of squatting with the prevalence of tibiofemoral OA as well as with the prevalence of patellofemoral knee OA, while adjusting for age and other potential confounding factors. We used the same approach to assess the relationship between squatting and tibiofemoral OA in the medial compartment and in the lateral compartment. Finally, we estimated the impact of squatting at age 25 on the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in the Framingham OA Study.Results. Squatting was very common among the Chinese subjects: ϳ40% of men and ϳ68% of women reported squatting >1 hour per day at age 25. The prevalence of tibiofemoral OA increased as the time spent squatting at age 25 increased in both the men and the women. Compared with subjects who squatted <30 minutes per day at age 25, the multivariable-adjusted prevalence odds ratios of tibiofemoral OA were 1.1 for time spent squatting of 30-59 minutes/day, 1.0 for 60-119 minutes/day, 1.7 for 120-179 minutes/day, and 2.0 for >120 minutes/day among the men (P for trend ‫؍‬ 0.074), and the respective odds ratios among the women were 1.4, 1.3, 1.2, and 2.4 (P for trend ‫؍‬ 0.077). A weaker association with patellofemoral OA was found. Prolonged squatting in daily life was more strongly associated with medial knee OA than with lateral disease in the men, but had a similar effect on both knee compartments in the women. After adjusting for the impact of squatting, the age-adjusted difference in prevalence of tibiofemoral OA was reduced from an excess of 14.4% to 9.5% in the Chinese women, but the difference in prevalence of tibiofemoral OA in the Chinese men increased after adjustment for age and squatting, from 2.9% lower to 7.0% lower as compared with their white counterparts.Conclusion. Prolonged squatting is a strong risk factor for tibiofemoral knee OA among elderly Chinese subjects in Beijing, and accounts for a substantial Supported by NIH grants AR-43873 and AR-47785.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: The Beijing Osteoarthritis Study

Hunter¹,

Nevitt²,

Xu³

et al. 2004

Arthritis & Rheumatism

120

View full text Add to dashboard Cite

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“…Musculoskeletal loading is influenced by a number of inter-individual factors such as weight [26] and gender [21,38], as well as the activity being undertaken [10,11,32,39,49]. Determining the in vivo loading environment in the human knee is difficult due to the combination of complex structural anatomy, complicated movements [44], and dynamic, often indeterminate muscle function.…”

Section: Introductionmentioning

confidence: 99%

Tibio‐femoral loading during human gait and stair climbing

Taylor

Heller

Bergmann

et al. 2004

Journal Orthopaedic Research

318

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Surgical intervention of the knee joint routinely endeavors to recreate a physiologically normal joint loading environment. The loading conditions resulting from osteotomies, fracture treatment, ligament replacements, and arthroplasties of the knee are considered to have an impact on the long term clinical outcome; however, knowledge regarding in vivo loading conditions is limited. Using a previously validated musculoskeletal lower limb model, we predicted the tibio-femoral joint contact forces that occur in the human knee during the common daily activities of walking and stair climbing. The average resultant peak force during walking was 3.1 times body weight (BW) across four total hip arthroplasty patients. Inter-individual variations proved larger than the variation of forces for each patient repeating the same task. Forces through the knee were considerably larger during stair climbing than during walking: the average resultant peak force during stair climbing was 5.4 BW although peaks of up to 6.2 BW were calculated for one particular patient. Average anteroposterior peak shear components of 0.6 BW were determined during walking and 1.3 BW during stair climbing. These results confirm both the joint contact forces reported in the literature and the importance of muscular activity in creating high forces across the joint. The magnitudes of these forces, specifically in shear, have implications for all forms of surgical intervention in the knee. The data demonstrate that high contact and shear forces are generated during weight bearing combined with knee flexion angles greater than approximately 15". Clinically, the conditions that produce these larger contact forces should be avoided during post-operative rehabilitation.

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“…In general, gait and climbing slopes required greater than 90°knee flexion, using stairs and getting in and out of chairs required 90°to 120°fl exion, and getting in and out of a bath required 135°fl exion [40,50]. Individuals typically need 111°to 165°k nee flexion for kneeling, squatting, and sitting crosslegged [21,39,41]. Activities such as golf, catching in a softball game, meditation, yoga, and gardening often require knee flexion greater than 150° [39,50].…”

Section: Introductionmentioning

confidence: 99%

“…This change was made to increase the contact area between the posterior condyles and the tibial insert in deep flexion. However, if the contact area is not adequate, the end result may be increased polyethylene wear attributable to high contact stresses in terminal flexion [9,41]. Also, the smaller radii of curvature require resection of an additional 2 to 4 mm of bone from the posterior condyles.…”

Section: Introductionmentioning

confidence: 99%

2009 Marshall Urist Young Investigator Award: How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?

Huddleston¹,

Scarborough

Goldvasser

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Although high-flexion TKA designs aim to safely accommodate deep flexion, it is unknown how often patients use deep flexion outside the laboratory. We used a validated smart-activity monitor to document the prevalence of knee flexion greater than 90°in 20 consecutive patients (21 knees) who had high-flexion TKAs, at a minimum of 2 years' followup. Patients wore the device continuously for a mean of 35.7 ± 0.5 hours. The 21 knees flexed more than 90°for an average of 10 ± 3.8 minutes (0.5%). Activities performed with flexion greater than 90°w ere, on average, 70% in single-limb stance, 12% moving from sitting to standing, 8% walking, 7% moving from standing to reclining, 2% stepping, 0.9% moving from lying to standing, and 0.1% running. Eight knees flexed greater than 120°for an average of 2.2 minutes (range, 0.2-15 minutes), or 0.1% of the testing time. Activities performed with flexion greater than 120°were, on average, 90% in single-limb stance, 6% moving from sitting to standing, 3% walking, 0.6% moving from standing to reclining, 0.3% stepping, and 0.1% moving from lying to standing. Peak flexion used at any time during testing was, on average, 84%

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Mechanical loads at the knee joint during deep flexion

Cited by 202 publications

References 28 publications

Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: The Beijing Osteoarthritis Study

Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: The Beijing Osteoarthritis Study

Tibio‐femoral loading during human gait and stair climbing

2009 Marshall Urist Young Investigator Award: How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?

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