Knee adduction moment and development of chronic knee pain in elders

Abstract

Objective. To determine whether the adduction moment at the knee during locomotor activity contributes to the development of future chronic knee pain. Methods. We studied 132 community-dwelling elders who had undergone a full kinetic and kinematic motion analysis while performing 4 different activities: standing, walking, rising from a chair, and descending stairs. We contacted the participants 3-4 years after their baseline locomotion analysis and identified those who reported no knee pain at the time of motion analysis but who subsequently developed new chronic knee pain at followup. We examined whether the development of new chronic knee pain was associated with higher peak adduction moment at the knee during activities, measured at baseline. Results. Of the 132 elders evaluated in 1995-1996, 118 (89%) were contacted in 1999. Of the 118 contacted, 80 (mean age 75 years; 78% women) had no lower extremity prosthetic joints at baseline, no known underlying inflammatory arthritis at baseline nor followup, and no baseline knee pain. At followup, 7 had developed new chronic knee pain defined as pain or stiffness on most days of the month and with walking 2 blocks or using stairs. Compared with those who did not develop knee pain, those who did develop new chronic knee pain had higher baseline adduction moments for all activities (P ‫؍‬ 0.01), ranging from 8% higher during chair rise to 39% higher during stair descent. Conclusion. We found that greater adduction moment at the knee during activities contributes to the development of future chronic knee pain. Our results suggest that biomechanical factors may play an important role in the pathogenesis of knee pain and should be studied further.

Update on hip and knee arthroplasty: Current state of evidence

“…According to McGibbon et al (88,89) some individuals may "functionally adapt" by allowing one joint to compensate for the reduced power in the hip or knee joint. Others may "neuromuscularly adapt" by transferring a load away from the affected hip or knee joint or by inhibiting movement at that joint (83,90). Whether these adaptations should be permitted or eliminated, and how best to measure and address them, warrants further investigation (91).…”

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

“…Knee joint loading, estimated using surrogate measures such as the external knee adduction moment (EKAM), has been implicated in both the development of knee pain and radiographic progression of medial knee OA in older adults (2,3). Knee load during walking is also positively associated with levels of subchondral bone change (4), worsening of bone marrow lesions (5), cartilage loss (6), and progression to total knee replacement in those with established disease (7).…”

Medial knee joint loading during stair ambulation and walking while carrying loads

“…Studies have observed that during walking, higher peak KAM magnitudes are related to the development of knee pain [3] and with a 6.5-fold increase in risk of knee OA progression for every one percent increase in KAM (normalised by body weight x height) [4]. Accumulating cross-sectional evidence indicates an association between peak KAM and medial tibial cartilage degradation in people with knee OA [5,6].…”