Self-reported Knee Instability Research Articles

Do self-reported knee instability, difficulty twisting, and knee confidence change after exercise and education in patients with knee osteoarthritis?

Do self-reported knee instability, difficulty twisting, and knee confidence change after exercise and education in patients with knee osteoarthritis?

Influence of Self-Reported Knee Instability on Outcomes Following Education and Exercise: A Cohort Study of 2,466 Patients With Knee Osteoarthritis.

To study the influence of self-reported knee instability on changes in knee pain and gait speed following patient education and supervised exercise therapy in patients with knee osteoarthritis (OA). We included patients enrolled in the Good Life With Osteoarthritis in Denmark (GLA:D) program, an 8-week education and supervised neuromuscular exercise program. Patients were classified into 4 groups according to their level of self-reported knee instability (never; rarely; sometimes; most of the time or all the time). Knee pain intensity was evaluated on a 0-100 mm scale and gait speed from the 4 × 10 meters fast-paced walk test at baseline and after the program. Using linear regression, we examined the association between knee instability and the change in pain and gait speed, respectively. Sex, age, body mass index, physical activity level, and previous knee surgery were covariates in adjusted models. Among 2,466 patients with knee OA, mean baseline pain and gait speed varied between 38-59 mm and 1.39-1.56 meters/second in patients experiencing no instability and patients experiencing instability most or all the time, respectively. All instability groups improved in pain and gait speed. Compared to the no instability group, patients reporting instability most or all the time experienced larger improvements in pain (4.3 mm [95% confidence interval 1.2, 7.5]), while no difference between instability groups was found for gait speed. Knee OA patients with self-reported instability seem to benefit even more from a patient education and supervised exercise therapy program than OA patients without instability.

Association of a Wider Medial Gap (Medial Laxity) in Flexion with Self-Reported Knee Instability After Medial-Pivot Total Knee Arthroplasty

Background: Medial-pivot total knee arthroplasty (TKA) is designed with high articular conformity in the medial compartment in order to achieve stability. The subjective outcome of patients has been reported to be good postoperatively; however, the association between the objective and subjective knee stability and the influence of subjective stability on the overall outcomes of TKA remained unknown. Our hypothesis was that postoperative flexion joint-gap imbalance could affect subjective knee instability following TKA in medial-pivot prostheses. The purpose of this study was to analyze the association between the joint gap in flexion and subjective knee instability and between subjective knee instability and outcomes following medial-pivot TKA. Methods: A total of 769 patients who underwent primary TKA with use of medial-pivot prostheses were enrolled. Clinical outcomes included knee range of motion, Knee Society Score-2011 (KSS-2011), Forgotten Joint Score-12 (FJS-12), patient-reported subjective knee instability, and axial knee radiography to assess flexion joint-gap balance measured at the final follow-up. Clinical outcomes were compared between patients with and without subjective knee instability. Moreover, associated factors were analyzed for postoperative subjective knee instability. Results: Overall, 177 patients (23%) reported experiencing postoperative subjective knee instability. Knee flexion (p = 0.04); KSS-2011 symptom (p<0.001), satisfaction (p<0.001), expectation (p=0.008), and activity (p<0.001) subscales; and FJS-12 (p < 0.001) were significantly worse in patients with subjective knee instability. The KSS-2011 subjective score differences were greater than the minimal clinically important difference. Older age at the time of surgery (odds ratio, 1.04; p = 0.04) and a wider postoperative joint gap in flexion on the medial side (odds ratio, 1.21; p = 0.001) were significant risk factors for subjective knee instability. A gap angle of −2.9° (i.e., medial laxity) was the threshold to predict postoperative knee instability (sensitivity, 0.29; specificity, 0.91). Conclusions: Postoperative flexion joint-gap laxity on the medial side following medial-pivot TKA affected the patient-reported subjective knee instability scores. Postoperative KSS-2011 subjective scores following medial-pivot TKA were poorer in patients with subjective knee instability. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The effect of self-reported knee instability on plantar pressure and postural sways in women with knee osteoarthritis

BackgroundGiving way and knee instability are common problems in patients with knee osteoarthritis, disrupting the daily activities and balance of the affected individual. The present study aimed to evaluate the postural control status of women with knee osteoarthritis with and without self-report knee instability (KI).MethodsThis cross-sectional, single-blind study was conducted on 57 female patients with knee osteoarthritis. The patients were selected based on the inclusion and exclusion criteria and divided into two groups of with KI (n = 26) and without KI (n = 31). Fear of movement was assessed using the Tampa questionnaire, the degree of knee instability was measured based on the Fitzgard scale, the static and dynamic balance of the subjects were evaluated with open and closed eyes using a Biodex balance device, and foot pressure distribution situation was measured using a FDM-S-Zebris device.ResultsMean comparison showed a significant difference between the subjects with and without KI in static balance only in anterior–posterior direction with open eyes (p = 0.01) and closed eyes (p = 0.0001). In the dynamic balance test, the subjects in both groups had significant differences in terms of all the indicators of anterior–posterior stability (p = 0.001), medial–lateral stability (p = 0.0001), and overall stability (p = 0.0001) with closed eyes. However, no significant difference was observed with open eyes (p > 0.05). Multiple regression also indicated significant positive correlations between pain intensity and disease duration with the degree of KI (p < 0.05).ConclusionsAccording to the results, there were significant differences between the mean pain scores, static and dynamic balance, and the rate of fall between the women with knee osteoarthritis with and without the KI index. Therefore, patients with knee osteoarthritis, which also has an index of KI, are more susceptible to falls, and proper strategies are required to reduce the level of KI in these patients.

The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial

BackgroundKnee Instability (KI) is described as a sense of knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (60–80%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). In this line, the present study targeted the effect of two interventions on self-reported KI and affected factors.MethodsIn this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren–Lawrence ≥ II) of KOA were selected. Patients were divided into three groups namely, aquatic (n = 12), Total Resistance exercises (TRX) (n = 12) and control (n = 12) by random. Then both 8-week TRX and aquatic exercises were carried out by experimental groups. The following measure were taken before and after interventions: Pain by visual analog scale (VAS), balance by Berg Balance Scale (BBS), quadriceps strength by dynamometer, knee flexion range of motion (ROM) by inclinometer, knee stiffness with Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and self-reported KI with Felson’s questionnaire.ResultsThe results demonstrated that KI, VAS, BBS improved over time both in TRX and aquatic groups significantly (p < 0.05), but WOMAC(stiffness), knee flexion ROM, and quadriceps strength were significantly improved over time only for TRX (p < 0.05). Post hoc test, also, showed that there were significant differences between interventions and control groups (p < 0.05) for the VAS, KI, BBS, but for WOMAC(stiffness), a significant difference was observed only between TRX and control groups (p = 0.05).ConclusionsAlthough TRX and aquatic interventions had a similar effect on the patients’ balance, pain and KI, TRX had more effect on WOMAC(stiffness), quadriceps strength, and knee flexion ROM than aquatic exercises.Trial registrationThis study was registered in the Iranian Clinical Trial Center with the number IRCT20181222042070N1, http://www.irct.ir/trial/36221, registered 02 February 2019.

Factors affecting return to sport following hamstrings anterior cruciate ligament reconstruction in non-elite athletes

Anterior cruciate ligament (ACL) rupture is a common injury affecting non-elite and elite athletes. Although most ACL reconstructions restore the mechanical stability of the injured knee, the rate of return to sport (RTS) is varied. We aimed to identify why non-elite athletes fail to return to pre-injury sport level. The primary objective was to assess the frequency of RTS (including type of sport, timing, level, and duration), and the secondary objective was to assess the surgical (injury, type of surgery, re-injury) and patient (demographics, function, symptoms, social, psychological) factors affecting RTS, using a multivariate analysis. Level III, retrospective cohort study. We evaluated 78 consecutive non-elite athletes undergoing hamstring ACL reconstruction using medical records and questionnaires. Mean follow-up was 50months (24-224months). Athletes were divided into return to sport (RTS) and not returning to sport (NRTS) groups for comparative and multivariate analyses, to identify independent predictors of RTS status. Mean age was 31.5years (18-51), and 46 were male (59%). The RTS rate was 56.4% (44), with most athletes returning between 9 and 12months, and then continuing to play for > 60months. Fear of re-injury was the highest reported reason for NRTS. There were no significant differences in demographics, concomitant injury, adjuvant surgery, and type of sport between the two groups. Mean Tegner scores were significantly higher in RTS group post-injury (6.9 vs 4.6) and at present (6.6 vs 4.6). The International Knee Documentation Committee (IKDC) score for the RTS group also increased significantly from pre-injury 70.8 (49.1-93.4) to 83.9 (24.1-100) post-injury (p < 0.001). Fear of re-injury, lack of confidence, lack of time, and change in job were significant factors in the NRTS group. Playing soccer, giving way, and change of job independently predicted RTS status from multivariate analysis. A significant number of non-elite athletes did not RTS following ACL reconstruction, and this was influenced by a combination of activity level, sport, self-reported knee instability, and psycho-social factors. Importantly, some of these can be predicted and managed with improved, individualized post-operative physical and psychological rehabilitation programmes. These data also allow surgeons to better counsel athletes before ACL reconstruction on their likelihood of RTS.

Self-reported Instability in Knee Osteoarthritis: A Scoping Review of Literature.

Knee Osteoarthritis (OA) is a disabling musculoskeletal condition among the elderly. Self-reported instability is one of the impairments associated with osteoarthritis. A complete understanding of the self-reported instability in knee OA is essential, to identify the best strategies for overcoming this impairment. The focus of this scoping review is to provide an overview of evidence supported information about the prevalence and other associated features of selfreported instability in Knee OA. A broad search of the database PubMed with keywords such as knee osteoarthritis and instability resulted in 1075 articles. After title abstract and full-text screening, 19 relevant articles are described in the review. Overall, there is less amount of published literature on this topic. Studies reported prevalence rates of more than 60% for self-reported instability in knee osteoarthritis, which causes functional deterioration and high fear of falls. The most probable causative factors for self-reported instability in knee OA were altered sensory mechanisms and decreased muscle strength. To conclude, self-reported knee instability in knee OA requires thorough evaluation and directed treatment with further studies providing rationalistic evidence-based management strategies. The current literature regarding self-reported knee instability is summarized, highlighting the research gaps.

Prevalence of self-reported knee instability in patients with meniscal tears with and without concomitant knee osteoarthritis

Prevalence of self-reported knee instability in patients with meniscal tears with and without concomitant knee osteoarthritis

Does the presence of self-reported knee instability impact the response to walking surface translations in those with knee osteoarthritis?

Does the presence of self-reported knee instability impact the response to walking surface translations in those with knee osteoarthritis?

Self-reported knee instability associated with pain, activity limitations, and poorer quality of life before and 1 year after total knee arthroplasty in patients with knee osteoarthritis.

Information on the association of self-reported knee instability with clinical outcomes after Total Knee Arthroplasty (TKA) and 1 year follow-up is scarce. The aims were to determine (i) the course and prevalence of self-reported knee instability before and 1 year after TKA and (ii) the associations of preoperative, postoperative, and retained self-reported knee instability with pain, activity limitations, and quality of life (QoL) in patients with knee osteoarthritis. Patients undergoing primary TKA, selected from the Longitudinal Leiden Orthopaedics and Outcomes of OsteoArthritis Study, had their knee instability measured using a questionnaire. The Knee injury and Osteoarthritis Outcome Score pain, activity limitations, and QoL subscales were administered before and 1 year after surgery. Multivariable regression analyses were performed to examine associations between knee instability, pain, activity limitations, and QoL, adjusted for covariates (age, gender, comorbidities, and radiographic severity). Of the 908 included patients, 649 (71%) and 187 (21%) reported knee instability before and following TKA, respectively. Of the patients with preoperative knee instability, this perception was retained in 165 (25%) cases. Knee instability was preoperatively associated with pain (B -9.6; 95%CI: -12.4 to -6.7), activity limitations (B -7.5; 95%CI: -10.2 to -4.8), and QoL (B -4.7; 95%CI: -7.0 to -2.4) and postoperatively with pain (B -15.0; 95%CI: -18.5 to -11.6), activity limitations (B -15.1; 95%CI: -18.4 to -11.8), and QoL (B -18.7; 95%CI: -22.3 to -15.3). Retained knee instability was associated with postoperative pain (B -15.1; 95%CI: -18.9 to -11.2), activity limitations (B -14.1; 95%CI: -17.8 to -10.4), and QoL (B -18.0; 95%CI: -21.7 to -14.3). In conclusion, in clinical care, self-reported knee instability is retained postoperatively in 25% of the patients. Retained knee instability is associated with more pain, activity limitations, and poorer QoL postoperatively. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2671-2678, 2018.

No differences in objective dynamic instability during acceleration of the knee with or without subjective instability post-total knee arthroplasty.

IntroductionInstability after total knee arthroplasty is a critical problem. The purpose of this study was to clarify the stability of implanted knees during walking by comparing differences in dynamic instability during knee acceleration between individuals with or without previously experienced subjective instability, as measured by self-reported questionnaire.Materials and methodsWe examined 92 knees with medial pivot implants. Mean patient age and follow-up duration were 78.4 years and 32.8 months, respectively. An accelerometer was used to investigate the accelerations along three axes; that is, vertical (VT), mediolateral (ML), and anteroposterior (AP) directions in 3-dimensional (3D) space. The analysis in the stance phase and gait cycle was performed by: (1) root mean square (RMS) values of acceleration and (2) frequency domain analysis using fast Fourier transformation (FFT). A self-reported knee instability score was used for the subjective feeling of instability.ResultsA total of 76 knees did not feel unstable (group 0), but 16 knees felt unstable (group 1) in patients during activities of daily living. Regarding the RMS, there were no differences in each direction between the groups. For FFT, the cumulative amplitude in the frequency < 30 Hz also showed no significant differences in all directions between the groups during the stance phase (VT, p = 0.335; ML, p = 0.219; AP, p = 0.523) or gait cycle (VT, p = 0.077; ML, p = 0.082; AP, p = 0.499).DiscussionGait analysis based on the acceleration data showed that there were no between-group differences in objective dynamic instability during acceleration of the knee, with or without reports of previously experienced subjective instability, as assessed by the self-reported questionnaire.

The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis

BackgroundWe aimed to (i) evaluate the immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence, and (ii) to assess the difference in effect between a non-tight and a tight soft brace in patients with knee osteoarthritis (OA).MethodsForty-four patients with knee OA and self-reported knee instability participated in the single-session, laboratory, experimental study. A within-subject design was used, comparing a soft brace with no brace, and comparing a non-tight with a tight soft brace. The outcome measures were pain, self-reported knee instability and knee confidence during level and perturbed walking on the treadmill and activity limitations (10-m walk test and the get up and go (GUG) test). Linear mixed-effect model analysis for continuous outcomes and logistic generalized estimating equations for categorical outcomes were used to evaluate the effect of wearing a soft brace.ResultsWearing a soft brace significantly reduced pain during level walking (B − 0.60, P = 0.001) and perturbed walking (B − 0.80, P < 0.001), reduced the time to complete the 10-m walk (B − 0.23, P < 0.001) and the GUG tests (B − 0.23, P = 0.004), reduced self-reported knee instability during level walking (OR 0.41, P = 0.002) and perturbed walking (OR 0.36, P < 0.001), and reduced lack of confidence in the knees during level walking (OR 0.45, P < 0.001) and perturbed walking (OR 0.56, P < 0.001), compared with not wearing a soft brace. There was no difference in effects between a non-tight and tight brace, except for the 10-m walk test. Wearing a tight brace significantly reduced the time to complete the 10-m walk test in comparison with wearing a non-tight brace (B − 0.11, P = 0.03).ConclusionThe results of this study indicate that a soft brace is an efficacious intervention targeting pain, activity limitations, self-reported knee instability, and knee confidence in the immediate term in patients with knee OA. Further studies are needed evaluating the mode of action based on exerted pressure, and on the generalization to functioning in daily life.Trial registrationtrialregister.nl, NTR6363. Retrospectively registered on 15 May 2017.

No associations between self-reported knee joint instability and radiographic features in knee osteoarthritis patients prior to Total Knee Arthroplasty: A cross-sectional analysis of the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis study (LOAS) data

BackgroundTo describe the prevalence of self-reported knee joint instability in patients with pre-surgery knee osteoarthritis (OA) and to explore the associations between self-reported knee joint instability and radiological features. MethodsA cross-sectional study including patients scheduled for primary Total Knee Arthroplasty (TKA). Self-reported knee instability was examined by questionnaire. Radiological features consisted of osteophyte formation and joint space narrowing (JSN), both scored on a 0 to three scale. Scores >1 are defined as substantial JSN or osteophyte formation. Regression analyses were provided to identify associations of radiological features with self-reported knee joint instability. ResultsTwo hundred and sixty-five patients (mean age 69years and 170 females) were included. Knee instability was reported by 192 patients (72%). Substantial osteophyte formation was present in 78 patients (41%) reporting and 33 patients (46%) not reporting knee joint instability. Substantial JSN was present in 137 (71%) and 53 patients (73%), respectively. Self-reported knee instability was not associated with JSN (relative to score 0, odds ratios (95% CI) of score 1, 2 and 3 were 0.87 (0.30–2.54), 0.98 (0.38–2.52), 0.68 (0.25–1.86), respectively) or osteophyte formation (relative to score 0, odds ratios (95% CI) of score 1, 2 and 3 were 0.77 (0.36–1.64), 0.69 (0.23–1.45), 0.89 (0.16–4.93), respectively). Stratified analysis for pain, age and BMI showed no associations between self-reported knee joint instability and radiological features. ConclusionSelf-reported knee joint instability is not associated with JSN or osteophyte formation.

The effect of soft brace on self-reported knee instability and confidence, pain and physical function in patients with knee osteoarthritis

The effect of soft brace on self-reported knee instability and confidence, pain and physical function in patients with knee osteoarthritis

Self-reported Knee Instability Associated with Pain and Activity Limitations Prior and One Year after Total Knee Arthroplasty in Patients with Knee Osteoarthritis

Self-reported Knee Instability Associated with Pain and Activity Limitations Prior and One Year after Total Knee Arthroplasty in Patients with Knee Osteoarthritis

Association between anteroposterior laxity in mid-range flexion and subjective healing ofinstability after total knee arthroplasty.

Flexion instability following total knee arthroplasty (TKA) is a common indication of early revision. The association between the objective anteroposterior (AP) laxity direction in mid-range flexion and the subjective healing of instability remains unclear; thus, this study aimed to clarify this association. In this study, 110 knees (74 females, 92 knees; 16 males, 18 knees) with medial pivot implants were examined with a median age of 79 (range 60-92) years for a median follow-up duration of 22 (range 6-125) months. AP laxity was measured using a KT-1000 arthrometer. Self-reported knee instability score was used for the subjective healing of instability. Eighty-seven knees did not feel unstable (Group 0), whereas 23 knees felt unstable (Group 1). There was a significant difference in AP displacement [Group 0: median 6mm; range 2-15mm and Group 1: median 8mm; range 4-14; p<0.0001]. The threshold value of 7mm was determined using the area under receiver operating characteristic curve of 0.79 [95% confidence interval (CI) 0.69-0.88, p<0.0001]. In multivariate analysis, AP displacement of ≥7mm was an independent risk factor for feelings of instability (odds ratio 7.695; 95% CI 2.306-25.674; p=0.001). AP laxity of ≥7mm represents a known cause of feelings of instability. By controlling AP laxity in TKAs, without stiffness in the knee, it is possible to prevent feelings of instability. The clinical relevance is that AP laxity of <7mm is one of the target areas in TKA. IV.

Predictors of self-reported knee instability among patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort.

The aims of the study were to (i) determine the prevalence and course of self-reported knee instability at 2-year follow-up and (ii) identify factors predictive of retention of self-reported knee instability among patients with established knee osteoarthritis (OA). Among 201 patients from the Amsterdam Osteoarthritis (AMS-OA) cohort, demographic characteristics, self-reported knee instability, muscle strength, proprioception, pain, and physical function were assessed at baseline and at 2years. Exercise over the past 2years was assessed by evaluating the medical files. The course of self-reported knee instability was determined in patients reporting instability at baseline. Baseline predictors of self-reported knee instability were determined by uni- and multivariable logistic regression analyses. At baseline, 123 (61%) patients reported knee instability, and of these, 85 (64%) patients reported instability 2years later, while 38 (29%) reported no instability 2years later. Poor proprioception and high pain assessed at baseline predicted retention of self-reported knee instability at 2years among patients with self-reported instability at baseline. Knee instability is highly prevalent among patients with knee osteoarthritis. In patients with self-reported knee instability, the majority retained instability over 2years. Poor proprioception and high pain predicted retention of self-reported knee instability over time.

Self-Reported Knee Instability Before and After Total Knee Replacement Surgery.

To determine the prevalence and burden of pain and activity limitations associated with retaining presurgery self-reported knee instability 6 months after total knee replacement (TKR) surgery and to identify early potentially modifiable risk factors for retaining knee instability in the operated knee after TKR surgery. A secondary analysis was performed using measures obtained from 390 participants undergoing primary unilateral TKR and participating in a randomized clinical trial. Self-reported knee instability was measured using 2 items from the Activities of Daily Living Scale of the Knee Outcome Survey. Outcome measures were knee pain (range 0-20) and physical function (range 0-68) on the Western Ontario and McMaster Universities Arthritis Index (WOMAC), stair-climb power, 50-foot walk time, knee range of motion, and isometric knee flexion and extension strength. In this study, 72% of participants reported knee instability just prior to surgery, with 32% retaining instability in the operated knee 6 months after surgery. Participants retaining operated knee instability had significantly more knee pain and activity limitations 6 months after surgery, with mean ± SD WOMAC scores of 4.8 ± 3.7 and 17.5 ± 11.1, respectively, compared to participants without knee instability, with 2.9 ± 3.1 and 9.8 ± 9.2. The multivariable predictor model for retained knee instability included a high comorbidity score (>6), low stair-climb power (<150 watts), more pain in the operated knee (>7 of 20), and younger age (<60 years). Self-reported knee instability is highly prevalent before and after TKR surgery and is associated with a considerable burden of pain and activity limitation in the operated knee. Increasing lower extremity muscle power may reduce the risk of retaining knee instability after TKR surgery.

A comparison of the composition of the knee index between subjects with mild and moderate knee osteoarthritis

A comparison of the composition of the knee index between subjects with mild and moderate knee osteoarthritis

Biomechanical and neuromuscular adaptations during the landing phase of a stepping-down task in patients with early or established knee osteoarthritis

BackgroundTo compare the knee joint kinematics, kinetics and EMG activity patterns during a stepping-down task in patients with knee osteoarthritis (OA) with control subjects. Methods33 women with knee OA (early OA, n=14; established OA n=19) and 14 female control subjects performed a stepping-down task from a 20cm step. Knee joint kinematics, kinetics and EMG activity were recorded on the stepping-down leg during the loading phase. ResultsDuring the stepping-down task patients with established knee OA showed greater normalized medial hamstrings activity (p=0.034) and greater vastus lateralis-medial hamstrings co-contraction (p=0.012) than controls. Greater vastus medialis-medial hamstrings co-contraction was found in patients with established OA compared to control subjects (p=0.040) and to patients with early OA (p=0.023). Self-reported knee instability was reported in 7% and 32% of the patients with early and established OA, respectively. ConclusionsThe greater EMG co-activity found in established OA might suggest a less efficient use of knee muscles or an attempt to compensate for greater knee laxity usually present in patients with established OA. In the early stage of the disease, the biomechanical and neuromuscular control of stepping-down is not altered compared to healthy controls.