Relationship between Quadriceps Tendon Young's Modulus and Maximum Knee Flexion Angle in the Swing Phase of Gait in Patients with Severe Knee Osteoarthritis.

Bungo Ebihara,Takashi Fukaya,Hirotaka Mutsuzaki

doi:10.3390/medicina56090437

Abstract

Background and objectives: Decreased knee flexion in the swing phase of gait can be one of the causes of falls in severe knee osteoarthritis (OA). The quadriceps tendon is one of the causes of knee flexion limitation; however, it is unclear whether the stiffness of the quadriceps tendon affects the maximum knee flexion angle in the swing phase. The purpose of this study was to clarify the relationship between quadriceps tendon stiffness and maximum knee flexion angle in the swing phase of gait in patients with severe knee OA. Materials and Methods: This study was conducted from August 2018 to January 2020. Thirty patients with severe knee OA (median age 75.0 (interquartile range 67.5–76.0) years, Kellgren–Lawrence grade: 3 or 4) were evaluated. Quadriceps tendon stiffness was measured using Young’s modulus by ShearWave Elastography. The measurements were taken with the patient in the supine position with the knee bent at 60° in a relaxed state. A three-dimensional motion analysis system measured the maximum knee flexion angle in the swing phase. The measurements were taken at a self-selected gait speed. The motion analysis system also measured gait speed, step length, and cadence. Multiple regression analysis by the stepwise method was performed with maximum knee flexion angle in the swing phase as the dependent variable. Results: Multiple regression analysis identified quadriceps tendon Young’s modulus (standardized partial regression coefficients [β] = −0.410; p = 0.013) and gait speed (β = 0.433; p = 0.009) as independent variables for maximum knee flexion angle in the swing phase (adjusted coefficient of determination = 0.509; p < 0.001). Conclusions: Quadriceps tendon Young’s modulus is a predictor of the maximum knee flexion angle. Clinically, decreasing Young’s modulus may help to increase the maximum knee flexion angle in the swing phase in those with severe knee OA.

Highlights

Knee osteoarthritis (OA) has a complex pathogenesis that involves mechanical, inflammatory, and metabolic factors, which leads to joint destruction, and causes disability [1]
The purpose of this study was to clarify the relationship between quadriceps tendon stiffness and the maximum knee flexion angle in the swing phase of gait in patients with severe knee OA
The independent variables included measurement values that were significantly correlated with the maximum knee flexion angle in the swing phase, and included quadriceps tendon Young’s modulus, gait speed, cadence, and step length

Summary

Introduction

Knee osteoarthritis (OA) has a complex pathogenesis that involves mechanical, inflammatory, and metabolic factors, which leads to joint destruction, and causes disability [1]. The maximum knee flexion angle in the swing phase is decreased in patients with severe knee OA [8]. A decreased knee flexion angle in the swing phase can be one of the causes of falls. Decreased knee flexion in the swing phase of gait can be one of the causes of falls in severe knee osteoarthritis (OA). The quadriceps tendon is one of the causes of knee flexion limitation; it is unclear whether the stiffness of the quadriceps tendon affects the maximum knee flexion angle in the swing phase. The purpose of this study was to clarify the relationship between quadriceps tendon stiffness and maximum knee flexion angle in the swing phase of gait in patients with severe knee OA. Thirty patients with severe knee OA (median age 75.0 (interquartile range 67.5–76.0) years, Kellgren–Lawrence grade: 3 or 4) were evaluated.

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