Postural stability and its relation to knee flexor/extensor strength ratio in women with mild to moderate unilateral knee osteoarthritis: a case-control study

Abstract

Purpose/Aim Knee muscles strength is an important factor influencing postural stability in patients with knee osteoarthritis (KOA). However, there is no evidence regarding the relationship between the knee flexor/extensor strength ratio, which is suggested to be a good indicator of knee stability, and postural stability. We aimed to investigate postural stability and its relation to knee flexor and extensor strength and strength symmetry in women with KOA. Materials and Methods Thirty-five women with unilateral KOA and thirty-five asymptomatic women were assessed with the Prokin system to collect the following parameters during quiet standing with eyes-open and eyes-closed: ellipse area, perimeter, forward-backward standard deviation, mediolateral standard deviation, the average centre of pressure displacement on the x- and y-axises (COPX and COPY), and the limit of stability (LoS) score. Higher scores mean better balance for LoS and poorer balance for other parameters. Knee flexor and extensor strength were assessed bilaterally with the Lafayette hand-held dynamometer. Results The COPX during standing with eyes-closed was higher in women with KOA than controls and the LoS score was lower (p < 0.05, Cohens’d = 0.72 and 0.65). Postural stability was correlated with knee muscles strength and the flexor/extensor strength ratios in both groups (r = between 0.395 and 0.456 for LoS, r = between −0.335 and −0.639 for the others, p < 0.05). Conclusions Women with KOA had poorer postural stability in the mediolateral direction during standing with eyes-closed and a worse LoS score than controls. Postural stability was related to knee flexor and extensor strength and the flexor/extensor strength ratio in women.