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Sagittal plane dynamic knee joint stiffness during gait in subjects with early and established medial knee osteoarthritis
Abstract   Peer reviewed

Sagittal plane dynamic knee joint stiffness during gait in subjects with early and established medial knee osteoarthritis

A. Mahmoudian, J.H. van Dieën, I.A. Baert, S.M. Bruijn, F.P. Luyten, G.S. Faber and S.M. Verschueren
Osteoarthritis and Cartilage, Vol.24
Amsterdam, Netherlands, 04/2016
04/2016

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Abstract

Joint Pain Joint Stiffness Knee Pain
Purpose: Individuals with osteoarthritis (OA) of the knee demonstrate a decreased knee joint excursion in the sagittal plane during the loading response, along with changes in the moments during this time. Although the kinematic and kinetic characteristics of the knee joint during loading response have been investigated extensively, the interaction between changes in the sagittal plane joint moments and angles (dynamic joint stiffness), is not well-understood in this population, especially not in the early stages of the disease. Therefore, the aim of this study was to investigate dynamic joint stiffness during the loading response phase of gait in patients with early medial knee OA compared to a group of healthy controls, as well as a group of patients with established knee OA. Furthermore, we studied between-group differences in changes in the sagittal plane Ground Reaction Force (GRF), as a measure of loading force during the loading response phase. Methods: Fifty patients with early (n=29) and established (n=21) medial knee OA and 26 asymptomatic controls (all women) were evaluated. Subjects walked barefoot along a 12-meter walkway at a self-selected speed, while a 3D motion analysis system and force platforms were used to record sagittal plane knee joint angles, moments and GRF. Dynamic knee joint stiffness (DJS) during the loading response was calculated by dividing the change in knee joint flexion moment by the change in joint flexion angle from heel contact to maximum knee flexion angle. Results: Early OA patients showed no significant increase in dynamic joint stiffness or sagittal plane knee joint loading during the loading response of gait, compared to controls. Subjects with established medial knee OA presented significantly higher dynamic joint stiffness, along with decreased knee joint excursion (FlexExc) in the sagittal plane, during the loading response of gait compared to both subjects with early medial knee OA (PDJS=0.038 and PFlexExc=0.004, respectively) and healthy controls (PDJS=0.015 and PFlexExc=0.008, respectively) (figure 1). There were no significant changes in the sagittal plane GRF, neither for the early OA group nor for the established OA group, compared to the control group. Conclusions: Subjects with established knee OA have higher joint stiffness, which was not the case for the subjects in the early stages of the disease. This might reflect a compensatory strategy developed by the osteoarthritic patients, to overcome the knee joint instability associated with established knee OA. However, the increased loading that might result from increased joint stiffness might in turn be responsible for long-term destructive changes associated with progression of knee OA.

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