Abstract
BackgroundSufficient lower extremity muscle strength is necessary for performing functional tasks, and individuals with knee osteoarthritis demonstrate thigh muscle weakness compared to controls. It has been suggested that lower muscle strength is associated with a variety of clinical features including pain, mobility, and functional performance, yet these relationships have not been fully explored in patients with symptomatic meniscal tear in addition to knee osteoarthritis. Our purpose was to evaluate the associations of quadriceps and hamstrings muscle strength with structural damage and clinical features in individuals with knee osteoarthritis and symptomatic meniscal tear.MethodsWe performed a cross-sectional study using baseline data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial. We assessed structural damage using Kellgren-Lawrence grade and the magnetic resonance imaging osteoarthritis knee score (MOAKS) for cartilage damage. We used the Knee Injury and Osteoarthritis Outcomes Score (KOOS) to evaluate pain, symptoms, and activities of daily living (ADL), and the Timed Up and Go (TUG) test to assess mobility. We assessed quadriceps and hamstrings strength using a hand-held dynamometer and classified each into quartiles (Q). We used Chi square tests to evaluate the association between strength and structural damage; and separate analysis of covariance models to establish the association between pain, symptoms, ADL and mobility with strength, after adjusting for demographic characteristics (age, sex and BMI) and structural damage.ResultsTwo hundred fifty two participants were evaluated. For quadriceps strength, subjects in the strongest quartile scored 14 and 13 points higher on the KOOS Pain and ADL subscales, respectively, and completed the TUG two seconds faster than subjects in the weakest quartile. For hamstrings strength, subjects in the strongest quartile scored 13 and 14 points higher on the KOOS pain and ADL subscales, respectively, and completed the TUG two seconds faster than subjects in the weakest quartile. Strength was not associated with structural damage.ConclusionsGreater quadriceps and hamstrings muscle strength was associated with less pain, less difficulty completing activities of daily living, and better mobility. These relationships should be evaluated longitudinally.
Highlights
Sufficient lower extremity muscle strength is necessary for performing functional tasks, and individuals with knee osteoarthritis demonstrate thigh muscle weakness compared to controls
We did not find a significant association between hamstrings strength and Knee Injury and Osteoarthritis Outcomes Score (KOOS) symptoms. In this cross-sectional study of individuals with symptomatic meniscal tear and knee osteoarthritis, we observed that greater quadriceps and hamstrings strength were significantly associated with less patient-reported pain and difficulty completing activities of daily living, and better objectively measured mobility after accounting for age, sex, body mass index (BMI) and structural damage
Our results suggest that hamstrings strength contributes to multiple activities of daily living as greater hamstrings strength associated with time to complete the Timed Up and Go (TUG) test, which comprises both balance and mobility, and KOOS ADL scores, which assesses the difficulty experienced while completing a variety of daily activities ranging from sitting to ascending and descending stairs
Summary
Sufficient lower extremity muscle strength is necessary for performing functional tasks, and individuals with knee osteoarthritis demonstrate thigh muscle weakness compared to controls. It has been suggested that lower muscle strength is associated with a variety of clinical features including pain, mobility, and functional performance, yet these relationships have not been fully explored in patients with symptomatic meniscal tear in addition to knee osteoarthritis. Identifying modifiable factors that contribute to pain, difficulty performing activities of daily living, and mobility is necessary to inform efficient therapeutic regimens that effectively reduce functional limitation in individuals with knee osteoarthritis. It has been suggested that lower quadriceps and hamstrings strength contribute to a variety of clinical features, including poorer patient-reported function [11, 12], worse physical performance [13,14,15] and disease progression [16]. As muscle strength is modifiable, understanding the associations between quadriceps and hamstrings strength and a broad set of clinical features could help to determine efficacious treatment targets
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