Associations Between Cadence and Knee Loading in Patients With Knee Osteoarthritis

Abstract

Objective To test the hypothesis that higher walking cadence is associated with lower knee loading, while controlling for walking speed, in patients with medial compartment tibiofemoral osteoarthritis (OA). Methods A total of 691 patients underwent quantitative gait analysis, including 3‐dimensional knee moments and temporospatial parameters. Using multivariate linear regression, we tested the association of walking cadence with the knee adduction moment angular impulse (a surrogate measure of medial knee compartment load throughout the stance), while controlling for walking speed. We repeated the analysis while also adjusting for sex, age, body mass index, radiographic OA, knee pain, lateral trunk lean, foot progression angle, and mechanical axis angle, and while replacing the knee adduction moment angular impulse with other surrogate measures of knee loading. Results While controlling for walking speed, we found that a lower cadence was associated with higher knee adduction moment angular impulse (standardized β = –0.396, P < 0.001), suggesting a 0.02% body weight × height × seconds (%BW × Ht × s) decrease in impulse for each step per minute increase in cadence (unstandardized β –0.020 %BW × Ht × s [95% confidence interval –0.027, –0.015]), and remained consistent after adjusting for covariates. A lower cadence was also associated with higher first (standardized β = –0.138, P = 0.010) and second peak knee adduction moment (standardized β = –0.132, P = 0.018), higher peak knee flexion moment (standardized β = –0.128, P = 0.049), and vertical ground reaction force (standardized β = –0.116, P = 0.035) in the adjusted analyses. Conclusion When controlling for walking speed, we found that a lower cadence is associated with higher knee loading per step in patients with medial tibiofemoral OA. Future research should investigate the potential beneficial biomechanical and clinical effects of increasing walking cadence in patients with knee OA.

Walk Smarter, Not Harder: Effects of Cadence Manipulation on Gait Biomechanics in Patients with Patellofemoral Osteoarthritis

“…The external knee adduction moment peak and angular impulse, both potential surrogates for medial compartment loads, have been associated with knee pain and disease progression (19,36). A previous study has shown that lower cadence is associated with higher knee adduction angular impulse in patients with medial knee OA (13). In the present study, walking with a lower cadence was also noted to increase the knee adduction angular impulse.…”

“…Recent work has shown that higher cadence during walking is associated with less future cartilage damage in individuals with or at risk of tibiofemoral OA (±patellofemoral OA) when statistically adjusting for walking speed (12). Lower cadence is associated with higher surrogate measures of knee loads (i.e., knee adduction angular moment, peak knee adduction moment, peak knee flexion moment, and vertical ground reaction force) in individuals with predominant medial tibiofemoral OA while statistically controlling for walking speed (13). This combined with the findings of our present study provide a rationale for investigating the short- and longer-term effects of increasing cadence on biomechanical and clinical outcomes in individuals with patellofemoral OA and/or tibiofemoral OA.…”

“…The dominant, yet untested, theory is that lower cadence results in greater knee loading, which may, in turn, contribute to greater cartilage damage. Other recent work supports this theory by showing that lower walking cadence is associated with higher surrogate measures of knee loading in individuals with predominant medial tibiofemoral OA when statistically controlling for walking speed (13). This has prompted the suggestion that rehabilitation should include gait retraining, as it may reduce harmful mechanical loads to the patellofemoral joint.…”

Running and Physical Activity in an Air-Polluted Environment: The Biomechanical and Musculoskeletal Protocol for a Prospective Cohort Study 4HAIE (Healthy Aging in Industrial Environment—Program 4)

“…It has been shown that the knee adduction moment during gait leads to higher knee cartilage degeneration [10]. In addition, it has been shown that higher walking cadence is associated with less cartilage osteoarthritis progression [11]. Especially given that biomechanical data processing is challenging, the biomechanical research to date has tended to focus on small samples rather than multidisciplinary epidemiological research.…”

Developing gait modification strategies to improve knee joint loading and clinical outcomes in adults with knee osteoarthritis

“…85 Similarly, a cross-sectional investigation of adults with medial tibiofemoral OA identified that patients with lower cadence exhibited greater peak KAM, peak KFM, and peak vertical GRF compared to patients with higher cadence. 86 However, most studies to date have only evaluated cadence as a marker of health relevant to physical activity or physical function following knee replacement 84,87 or anterior cruciate ligament reconstruction surgery. 88 It is thought that increasing preferred cadence at a fixed gait speed can decrease the frontal plane moment arm by shifting the center of pressure at initial foot contact toward the center of mass.…”