Higher Knee Flexion Moment During the Second Half of the Stance Phase of Gait Is Associated With the Progression of Osteoarthritis of the Patellofemoral Joint on Magnetic Resonance Imaging

Hsiang-Ling Teng, Toran D MacLeod, Thomas M Link, Sharmila Majumdar, Richard B Souza, Hsiang-Ling Teng, Toran D MacLeod, Thomas M Link, Sharmila Majumdar, Richard B Souza

Abstract

Study design: Controlled laboratory study, longitudinal design.

Objective: To examine whether baseline knee flexion moment or impulse during walking is associated with the progression of osteoarthritis (OA) with magnetic resonance imaging of the patellofemoral joint (PFJ) at 1 year.

Background: Patellofemoral joint OA is highly prevalent and a major source of pain and dysfunction. The biomechanical factors associated with the progression of PFJ OA remain unclear.

Methods: Three-dimensional gait analyses were performed at baseline. Magnetic resonance imaging of the knee (high-resolution, 3-D, fast spin-echo sequence) was used to identify PFJ cartilage and bone marrow edema-like lesions at baseline and a 1-year follow-up. The severity of PFJ OA progression was defined using the modified Whole-Organ Magnetic Resonance Imaging Score when new or increased cartilage or bone marrow edema-like lesions were observed at 1 year. Peak external knee flexion moment and flexion moment impulse during the first and second halves of the stance phase of gait were compared between progressors and nonprogressors, and used to predict progression after adjusting for age, sex, body mass index, and presence of baseline PFJ OA.

Results: Sixty-one participants with no knee OA or isolated PFJ OA were included. Patellofemoral joint OA progressors (n = 10) demonstrated significantly higher peak knee flexion moment (P = .01) and flexion moment impulse (P = .04) during the second half of stance at baseline compared to nonprogressors. Logistic regression showed that higher peak knee flexion moment during the second half of the stance phase was significantly associated with progression at 1 year (adjusted odds ratio = 3.3, P = .01).

Conclusion: Peak knee flexion moment and flexion moment impulse during the second half of stance are related to the progression of PFJ OA and may need to be considered when treating individuals who are at risk of or who have PFJ OA.

Keywords: WORMS; bone marrow lesions; cartilage; gait; kinetics.

Figures

FIGURE 1
FIGURE 1
Sagittal plane knee moment curve during the stance phase of walking of a sample trial. Joint moment is expressed as external moment. Positive and negative values indicate knee flexion and extension moments, respectively. The vertical dotted line indicates 50% of the stance phase. Peak knee flexion moment and flexion moment impulse are computed during the first and second halves of the stance phase. Knee flexion moment impulse was calculated as the integral of knee flexion moment (Nm/kg·m) with respect to time (milliseconds) when sagittal plane knee moment was positive (orange area).
FIGURE 2
FIGURE 2
Sagittal plane knee moments during the stance phase of walking for progressors and nonprogressors of patellofemoral joint osteoarthritis. Values are mean ± SD (error bars). *Significant group difference in the peak knee flexion moment during the second half of the stance phase.

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