A more informed evaluation of medial compartment loading: the combined use of the knee adduction and flexor moments

K Manal, E Gardinier, T S Buchanan, L Snyder-Mackler, K Manal, E Gardinier, T S Buchanan, L Snyder-Mackler

Abstract

Objective: To evaluate if the peak knee flexor moment (pKFM) provides unique and meaningful information about peak medial compartment loading above and beyond what is obtained from the peak knee adduction moment.

Methods: Standard video-based motion capture and EMG recordings were collected for 10 anterior cruciate ligament (ACL) reconstructed subjects walking at a self-selected speed. Knee joint moments were obtained using inverse dynamics and medial contact force was computed using an EMG-driven musculoskeletal model. Linear regression with the peak adductor moment entered first was implemented to isolate the unique contribution of the peak flexor moment to peak medial loading.

Results: Peak moments and medial contact force occurred during weight acceptance at approximately 23% of stance. The peak knee adduction moment (pKAM) was a significant predictor of peak medial loading (P = 0.004) accounting for approximately 63% of the variance. The pKFM was also a significant predictor (P = 0.009) accounting for an additional 22% of the variance. When entered together pKAM and pKFM accounted for more than 85% of the variance in peak medial compartment loading.

Conclusion: The combined use of the peak knee flexor and adductor moments provides a significantly more accurate estimate of peak medial joint loading than the peak adduction moment alone. More accurate inferences of joint contact force will assist clinicians and researchers investigating relationships between joint loading and the onset and progression of knee osteoarthritis (OA).

Keywords: Contact force; Electromyography; Gait; Modeling.

Conflict of interest statement

Conflicts of Interest: There are no conflicts of interest to report.

Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Ensemble averaged medial compartment contact force for 10 subjects walking at a self-selected speed (gray band = 95% confidence interval).
Figure 2
Figure 2
Ensemble averaged external knee adduction (KAM) and flexor (KFM) moments for 10 subjects walking at a self-selected speed. The gray bars represent 95% confidence intervals. An increasing positive value for KAM indicates an increasing external knee adduction moment. A larger negative value for KFM indicates a larger external knee flexion moment. Note the timing of peak KAM and KFM was almost identical.
Figure 3
Figure 3
Scatter plot of subjects' normalized pKAM and pKFM. There was a weak and nonsignificant correlation between pKAM and pKFM. The number contained within each data point is the subject ID while values reported in parentheses are the EMG-driven model predicted medial compartment contact forces.

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