Association of Thigh Muscle Strength With Knee Symptoms and Radiographic Disease Stage of Osteoarthritis: Data From the Osteoarthritis Initiative

Ruhdorfer, A.; Wirth, W.; Hitzl, Wolfgang; Nevitt, Michael C.; Eckstein, F.

doi:10.1002/acr.22317

Cited by 61 publications

(67 citation statements)

References 48 publications

(57 reference statements)

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“…Although baseline WOMAC pain scores were somewhat greater in early RKOA than in no-RKOA limbs (2.2±3.4 vs. 1.5±3.0), this difference (0.6) was lower than the minimal clinically important difference (MCID) of 4 points reported for WOMAC pain (11). It also was smaller than that in our previous between-knee study of painful vs. contralateral painless knees (4.4±3.5 vs. 0.6±1.7) (2) and smaller than that in a recent comparison of asymptomatic (WOMAC=0) vs. symptomatic OAI participants (WOMAC≥5) (12). Both cross-sectional studies (2;12) found statistically significant pain-related differences in muscle strength, independent of RKOA status, and the between-knee comparison (2) also reported significant side-differences in quadriceps ACASs.…”

Section: Discussioncontrasting

confidence: 75%

Thigh muscle cross-sectional areas and strength in knees with early vs knees without radiographic knee osteoarthritis: a between-knee, within-person comparison

Ruhdorfer

Dannhauer

Wirth

et al. 2014

Osteoarthritis and Cartilage

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Objective To compare cross-sectional and longitudinal side-differences in thigh muscle anatomical cross-sectional areas (ACSAs), muscle strength, and specific strength (strength/ACSA), between knees with early radiographic change vs. knees without radiographic knee osteoarthritis (RKOA), in the same person. Design 55 (of 4796) Osteoarthritis Initiative participants fulfilled the inclusion criteria of early RKOA in one limb (definite tibiofemoral osteophytes; no radiographic joint space narrowing [JSN]) vs. no RKOA (no osteophyte; no JSN) in the contralateral limb. ACSAs of the thigh muscles and quadriceps heads were determined using axial MRIs at 33%/30% femoral length (distal to proximal). Isometric extensor and flexor muscle strength were measured (Good Strength Chair). Baseline quadriceps ACSA and extensor (specific) strength represented the primary analytic focus, and two-year changes of quadriceps ACSAs the secondary focus. Results No statistically significant side-differences in quadriceps (or other thigh muscle) ACSAs, muscle strength, or specific strength were observed between early RKOA vs. contralateral limbs without RKOA (p≥0.44), neither in men nor in women. The two-year reduction in quadriceps ACSA in limbs with early RKOA was −0.9±6% (mean ± standard deviation) vs. −0.5±6% in limbs without RKOA (statistical difference p=0.85). Conclusion Our results do not provide evidence that early unilateral radiographic changes, i.e. presence of osteophytes, are associated with cross-sectional or longitudinal differences in quadriceps muscle status compared with contralateral knees without RKOA. At the stage of early unilateral RKOA there thus appears to be no clinical need for countervailing a potential dys-balance in quadriceps ACSAs and strength between both knees.

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Section: Discussioncontrasting

confidence: 75%

Thigh muscle cross-sectional areas and strength in knees with early vs knees without radiographic knee osteoarthritis: a between-knee, within-person comparison

Ruhdorfer

Dannhauer

Wirth

et al. 2014

Osteoarthritis and Cartilage

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“…In contrast, a strong association was found between knee pain and thigh muscle strength 11,12 with smaller quadriceps CSAs and lower extensor strength found in limbs with frequently painful knees than in contralateral painless limbs 12 . Further, cross-sectional cohort studies in >3000 participants suggested that knee pain, but not radiographic status, was significantly associated with extensor and flexor muscle strength 11 , and that extensor and flexor strength both were significantly associated with limb function, as assessed by the Western Ontario McMaster Universities (WOMAC) function score 4 . In a first longitudinal study, Beattie et al reported a significant decrease in quadriceps volume and a significant increase in thigh intermuscular fat (IMF) tissue content over 2 years in women with symptomatic KOA; however, the observed change did not exceed that in women without symptoms and radiographic change who had risk factors for KOA 13 .…”

Section: Introductionmentioning

confidence: 74%

Longitudinal (4 year) change of thigh muscle and adipose tissue distribution in chronically painful vs painless knees – data from the Osteoarthritis Initiative

Ruhdorfer

Wirth

Dannhauer

et al. 2015

Osteoarthritis and Cartilage

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Objective To evaluate 4-year longitudinal change in thigh muscle and adipose tissue content in chronically painful versus painless knees. Methods Knees from Osteoarthritis Initiative participants with non-acceptable symptom status (numerical rating scale ≥4) and frequent pain (≥6 months at baseline, year 2 and year 4 follow-up) were studied. These were matched with painless controls (bilateral NRS pain intensity≤1 and ≤infrequent pain at all 3 timepoints). 4-year longitudinal changes in thigh muscle anatomical cross-sectional areas (CSAs), isometric muscle strength, and in subcutaneous (SCF) and intermuscular fat (IMF) CSAs were obtained from magnetic resonance images (MRI) and were compared between groups (paired t-tests). Results 43 participants fulfilled the inclusion criteria of chronic pain, had complete thigh muscle MRI acquisitions and strength measurements, and a matched control. Quadriceps CSAs, but not extensor strength, showed a significant longitudinal decrease in chronically painful knees (-3.9%; 95%confidence interval [95 CI] -6.3%,-1.5%) and in painless controls (-2.4%; 95% CI -4.1%, -0.7%); the difference in change was not statistically significant (p=0.33). There was a significant 4-year gain in SCF in painful knees (8.1%; 95% CI 3.1%, 13%) but not in controls (0.0%; 95%CI -4.4%, +4.4%) with the difference in change being significant (p=0.03). The gain in IMF (∼5.2%) was similar between painful and painless knees. Conclusion This is the first paper to show a significant impact of (chronic) knee pain on longitudinal change in local subcutaneous adipose tissue. The effect of pain on subcutaneous fat appeared stronger than that on intermuscular adipose tissue and on muscle status.

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“…On the other hand, in consistence with our study, several studies so far have demonstrated the correlation between quadriceps strength and functionality. 19,20 The results of these studies indicated that decreased isometric quadriceps muscle strength is related to knee symptoms and WOMAC functional disability. 19,20 25-hydroxy vitamin D levels were not correlated with quadriceps muscle strength and patients' functional status in the current study.…”

Section: Discussionmentioning

confidence: 93%

“…19,20 The results of these studies indicated that decreased isometric quadriceps muscle strength is related to knee symptoms and WOMAC functional disability. 19,20 25-hydroxy vitamin D levels were not correlated with quadriceps muscle strength and patients' functional status in the current study. Similarly, Al-Jarallah et al 21 did not find any relationship between 25-(OH)D and the functional status of patients with primary knee OA in their crosssectional study.…”

Section: Discussionmentioning

confidence: 93%

Which Predicts Quadriceps Muscle Strength in Knee Osteoarthritis: Biological Markers or Clinical Variables?

et al. 2017

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Objectives: This study aims to evaluate the relationship between biological markers and quadriceps muscle strength, the correlation of clinical variables with quadriceps muscle strength, and the results according to the radiological severity in patients with knee osteoarthritis. Patients and methods: A total of 152 patients (22 males, 130 females; mean age 57.3±7.5 years; range 40 to 70 years) with primary knee osteoarthritis were included in the study. We evaluated biological markers of C-telopeptide of type I collagen, C-telopeptide of type II collagen, leptin, and osteocalcin along with 25-hydroxy vitamin D. We measured quadriceps muscle strength both by manual muscle tester and computerized isokinetic dynamometer. We evaluated pain and functional status of the patients by visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index. We analyzed the correlation between biological markers and quadriceps muscle strength along with clinical variables. We classified the strength of correlations as no-very weak, weak-moderate, moderate-strong, and excellent. Results: Of the patients, 76.9% (n=117) were obese. Quadriceps muscle strength measures were significantly lower in females than that in males. There was no-very weak correlation between biological marker levels and quadriceps muscle strength. However, weak-moderate correlations were found between clinical variables (pain and Western Ontario and McMaster Universities Osteoarthritis Index scores) and quadriceps muscle strength measures. Conclusion: Among the measured biological markers, none had any influence on quadriceps muscle strength in patients with knee osteoarthritis. However, pain and functional status of the patients might affect quadriceps muscle strength.

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Association of Thigh Muscle Strength With Knee Symptoms and Radiographic Disease Stage of Osteoarthritis: Data From the Osteoarthritis Initiative

Cited by 61 publications

References 48 publications

Thigh muscle cross-sectional areas and strength in knees with early vs knees without radiographic knee osteoarthritis: a between-knee, within-person comparison

Thigh muscle cross-sectional areas and strength in knees with early vs knees without radiographic knee osteoarthritis: a between-knee, within-person comparison

Longitudinal (4 year) change of thigh muscle and adipose tissue distribution in chronically painful vs painless knees – data from the Osteoarthritis Initiative

Which Predicts Quadriceps Muscle Strength in Knee Osteoarthritis: Biological Markers or Clinical Variables?

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