The use of a valgus knee brace on muscle cocontraction during walking and stair climbing in individuals with medial knee osteoarthritis

Abstract

Purpose: Self-reported knee instability is highly prevalent in knee osteoarthritis (OA) and affects daily physical function. An association between knee instability and muscle strength has been demonstrated in cross-sectional studies. However, no information is available on change in self-reported knee instability over time and whether change in muscle strength is associated with change in self-reported knee instability. Muscle strength itself is associated with knee joint proprioception and knee pain. Whether these factors are influencing the association between change in muscle strength and change in self-reported instability is unknown. Therefore, the aims of the study were (i) to determine the change in self-reported knee instability over two-year time, and (ii) to study the association between change in muscle strength and change in self-reported knee instability, controlled for the change in proprioception and pain over two-year time in patients with established knee OA. Methods: A total of 201 patients from the Amsterdam Osteoarthritis (AMS-OA) cohort were followed-up during two years. Self-reported knee instability, muscle strength, proprioception, pain and patient characteristics were assessed at baseline and 2 years later. Self-reported knee instability was defined as the sensation of an episode of buckling, shifting or giving way of the knee in the previous three months. Patients reporting knee instability were additionally asked for the number of episodes of instability, whether these episodes concerned the left, right or both knees, if any episodes had resulted in a fall, and the particular activity that induced an episode of instability. Muscle strength of the left and right leg was measured isokinetically (EnKnee, Enraf-Nonius, Rotterdam, Netherlands) at 60 /second. The mean muscle strength (i.e., extension and flexion) per leg was calculated to obtain a measure of overall leg muscle strength (Nm). Joint proprioception was measured as the threshold of detection of passive joint movement. Knee pain over the past week was assessed by an 11 point numeric rating scale (0e10), with higher scores representing more pain. A series of demographic variables were obtained including age, gender, height, weight, and duration of complaints. Difference between baseline and two-year values of self-reported knee instability, muscle strength, proprioception and pain was calculated with Student's t-test or when appropriate with Chi-square test. Linear regression analysis was used to determine the association between the change in knee instability and change in muscle strength. Results: Self-reported knee instability, muscle strength, proprioception and knee pain changed significantly over two-year time (p < .001, respectively). Univariate regression analysis showed that the change in muscle strength was significantly associated with change in knee joint stability, indicating that an increase in muscle strength over time resulted in an improvement in self-reported knee stability. Changes in proprioception and knee pai...

Knee Joint Biomechanics in Physiological Conditions and How Pathologies Can Affect It: A Systematic Review

“…Russell [50] reported that the medial muscle (VM-ST and VM-MG) and lateral muscle (VL-BF and VL-LG) cocontraction indices were not significantly different between MKOA patients and normal person, but the quadriceps strength was significantly lower for MKOA patients. Alzahrani [73] and Hubley-Kozey et al [84] represented that the medial and lateral muscle cocontraction was increased for the KOA patients.…”

“…Zhu et al [72] found that the KOA patients presented a longer gait time, a smaller stride length and ROM, a greater knee flexion angle at heel strike, and an unobvious fluctuation of knee flexion angle in the stand phase of walking. Alzahrani [73] indicated that the MKOA patients presented slower walking speeds, shorter step lengths, longer stance and double support time, and smaller cadence, stride length, and knee ROM. In the knee kinetics aspect, Russell [50] described that the knee adduction moment pattern was similar, but the magnitude was higher for MKOA patients compared to that for normal subjects in walking, as shown in Figure 7(c).…”

The effect of a knee brace in dynamic motion—An instrumented gait analysis

“…Osteoarthritis (OA) is the leading cause of musculoskeletal disability in most developed countries [1][2][3][4]. The prevalence increases with age and is higher in women than in men [4].…”

“…OA is characterized by a loss of cartilage in the affected joint, with the knee being the most frequently affected of all joints [1][2][3][4]. The main problems of OA-patients are pain and reduced mobility [1], therefore, patients need walking frames and analgesics [5]. The burden of OA on the population, healthcare system, and the overall economy will continue to increase in the future.…”

“…Previous studies have pointed out that further dynamic investigation is necessary to prove the effectiveness of knee braces for OA treatment. In most cases, former investigations on this issue have only examined the immediate effect of valgus knee braces on aspects such as knee loading [14] and adduction moment [1,15], muscle co-contraction [1,16], functional joint space and joint contact locations [17], pain [2,18], and balance rather than the lasting changes after a treatment period [1,9]. Literature research has shown that an analysis of the effect of varus knee braces was less common than valgus [7].…”