Abstract
Objective. To investigate the relationship between knee muscle strength and the external knee adduction moment during walking in obese knee osteoarthritis patients and whether disease severity influences this relationship. Methods. This cross-sectional study included 136 elderly obese (BMI > 30) adults with predominant medial knee osteoarthritis. Muscle strength, standing radiographic severity as measured by the Kellgren and Lawrence scale, and the peak external knee adduction moment were measured at self-selected walking speed. Results. According to radiographic severity, patients were classified as “less severe” (KL 1-2, N = 73) or “severe” (KL 3-4, N = 63). A significant positive association was demonstrated between the peak knee adduction moment and hamstring muscle strength in the whole cohort (P = .047). However, disease severity did not influence the relationship between muscle strength and dynamic medial knee joint loading. Severe patients had higher peak knee adduction moment and more varus malalignment (P < .001). Conclusion. Higher hamstring muscle strength relates to higher estimates of dynamic knee joint loading in the medial compartment. No such relationship existed for quadriceps muscle strength. Although cross sectional, the results suggest that hamstrings function should receive increased attention in future studies and treatments that aim at halting disease progression.
Highlights
Osteoarthritis (OA) of the knee is a major cause of disability [1] with the medial tibiofemoral compartment OA being most prevalent
The knee adduction moment (KAM) reflects the medial to lateral tibiofemoral load distribution and is widely used in the literature, and its magnitude is a strong predictor of presence and rate of disease progression [3, 6, 7]
The main finding of this study is the positive relationship between muscle strength and dynamic knee joint loading during walking
Summary
Osteoarthritis (OA) of the knee is a major cause of disability [1] with the medial tibiofemoral compartment OA being most prevalent. Other factors modulate joint loads during walking, for example, muscle forces, which are the largest contributors to knee loadings during walking [14, 15]. Strengthening exercises improve clinical findings in knee OA patients, such as pain and quality of life [21,22,23,24,25] Such positive clinical effects of muscle strengthening may be biomechanically explained by muscles protecting the joint. One would expect the suggested shock absorbing function of periarticular muscles to be a biomechanical benefit protecting the knee from excess loading and potentially reducing the rate of knee OA progression
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