The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis

Andriacchi, Thomas P.; Mündermann, Annegret

doi:10.1097/01.bor.0000240365.16842.4e

Cited by 515 publications

(429 citation statements)

References 31 publications

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“…The means and standard deviations for all variables of interest in this study (Table 2) were comparable to those in several studies [3,69], as were the mean knee adduction angle and moment curves during gait (Fig. 3) [53].…”

Section: Discussionsupporting

confidence: 84%

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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Section: Discussionsupporting

confidence: 84%

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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“…The area underneath the EKAM curve, the knee adduction angular impulse (KAAI), represents the cumulative effect of the EKAM over the stance phase (10). High medial knee loading during walking estimated using the EKAM and KAAI is predictive of structural progression in knee OA (3,5,6), under the tenet that high knee loading in the presence of established disease overwhelms the normal regulation of healthy tissue, precipitating ongoing structural change (11).…”

Section: Introductionmentioning

confidence: 99%

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Arnold

Wong

Jones

et al. 2016

Arthritis Care & Research

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Objective. Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there has been no definitive consensus on this topic. The aim of this systematic review and meta-analysis was to establish the within-subject effects of lateral wedge insoles on knee joint load in people with medial knee OA during walking. Methods. Six databases were searched from inception until February 13, 2015. Included studies reported on the immediate biomechanical effects of lateral wedge insoles during walking in people with medial knee OA. Primary outcomes of interest relating to the biomechanical risk of disease progression were the first and second peak external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI). Eligible studies were pooled using random-effects metaanalysis.Results. Eighteen studies were included with a total of 534 participants. Lateral wedge insoles resulted in a small but statistically significant reduction in the first peak EKAM (standardized mean difference [SMD] 20.19; 95% confidence interval [95% CI] 20.23, 20.15) and second peak EKAM (SMD 20.25; 95% CI 20.32, 20.19) with a low level of heterogeneity (I 2 5 5% and 30%, respectively). There was a favorable but small reduction in the KAAI with lateral wedge insoles (SMD 20.14; 95% CI 20.21, 20.07, I 2 5 31%). Risk of methodologic bias scores (quality index) ranged from 8 to 13 out of 16. Conclusion. Lateral wedge insoles cause small reductions in the EKAM and KAAI during walking in people with medial knee OA. Current evidence demonstrates that lateral wedge insoles appear ineffective at attenuating structural changes in people with medial knee OA as a whole and may be better suited to targeted use in biomechanical phenotypes associated with larger reductions in knee load.

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“…3,4 This persistent dysfunction may reduce the ability of individuals with ACLR to adapt to the demands of physical activity, resulting in abnormal knee-joint loading. [5][6][7] Researchers 8,9 have hypothesized that the combination of joint trauma from initial injury and surgery, along with long-term functional adaptation due to persistent lower extremity neuromuscular dysfunction, may predispose individuals with ACLR to higher rates of reinjury and knee-joint osteoarthritis. Understanding the clinical and neurophysiologic manifestations of quadriceps dysfunction after ACLR is essential to developing targeted treatment and clearer criteria for return to activity.…”

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confidence: 99%

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

Kuenze

Hertel

Weltman

et al. 2015

Journal of Athletic Training

109

116

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Context: Return to activity in the presence of quadriceps dysfunction may predispose individuals with anterior cruciate ligament reconstruction (ACLR) to long-term joint degeneration. Asymmetry may manifest during movement and result in altered knee-joint-loading patterns; however, the underlying neurophysiologic mechanisms remain unclear.Objective: To compare limb symmetry of quadriceps neuromuscular function between participants with ACLR and participants serving as healthy controls.Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 22 individuals with ACLR (12 men, 10 women) and 24 individuals serving as healthy controls (12 men, 12 women).Main Outcome Measure(s): Normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/ kg), quadriceps central activation ratio (CAR) (%), quadriceps motor-neuron-pool excitability (Hoffmann reflex to motor wave ratio), and quadriceps active motor threshold (AMT) (% 2.0 T) were measured bilaterally and used to calculate limb symmetry indices for comparison between groups. We used analyses of variance to compare quadriceps Hoffmann reflex to motor wave ratio, normalized knee-extension MVIC torque, quadriceps CAR, and quadriceps AMT between groups and limbs.Results: The ACLR group exhibited greater asymmetry in knee-extension MVIC torque (ACLR group ¼ 0.85 6 0.21, healthy group ¼ 0.97 6 0.14; t 44 ¼ 2.26, P ¼ .03), quadriceps CAR (ACLR group ¼ 0.94 6 0.11, healthy group ¼ 1.00 6 0.08; t 44 ¼ 2.22, P ¼ .04), and quadriceps AMT (ACLR group ¼ 1.13 6 0.18, healthy group ¼ 1.02 6 0.11; t 34 ¼À2.46, P ¼ .04) than the healthy control group.Conclusions: Asymmetries in measures of quadriceps function and cortical excitability were present in patients with ACLR. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Measuring the magnitude of asymmetry after ACLR represents an important step in understanding long-term reductions in self-reported function and increased rate of subsequent joint injury in otherwise healthy, active individuals after ACLR.Key Words: quadriceps activation, limb symmetry index, transcranial magnetic stimulation Key PointsThe anterior cruciate ligament reconstruction (ACLR) group exhibited a weaker, less activated quadriceps and less cortical excitability in the reconstructed limb than in the contralateral limb and in the limbs of the healthy control group. Asymmetry in quadriceps strength, activation, and cortical excitability persisted in individuals with ACLR beyond return to recreational activity. Chronic asymmetry indicated reduced dynamic force absorption at the knee and may explain the increased rate of knee reinjury and chronic joint degeneration after ACLR.

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The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis

Cited by 515 publications

References 31 publications

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

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

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Persistent Neuromuscular and Corticomotor Quadriceps Asymmetry After Anterior Cruciate Ligament Reconstruction

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