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Knee Flexion Contracture Associated With a Contracture and Worse Function of the Contralateral Knee: Data From the Osteoarthritis Initiative

Published:January 06, 2020DOI:https://doi.org/10.1016/j.apmr.2019.11.018

      Abstract

      Objective

      Patients at risk of developing knee osteoarthritis (OA) or those already diagnosed with knee OA may present with a knee flexion contracture (FC). A knee FC can cause pain and can decrease function. By altering lower extremity biomechanics, the effect of a knee FC goes beyond the affected joint. Compensatory movements during gait can chronically affect other joints in both lower limbs. Few studies describe the effect of a knee FC on, or direct assessment toward, the contralateral knee. We investigated the associations between knee FC with range of extension, function, pain, and stiffness of the contralateral knee.

      Design

      Cross-sectional, using the Osteoarthritis Initiative Database.

      Participants

      Outpatient cohort study, recruiting from 4 United States academic health care centers (N=4796). Two groups were included: those at risk of developing OA (n=3284 knees), and those already with radiographic OA (n=1390 knees).

      Main Outcomes Measures

      Maximum contralateral knee extension and Western Ontario and McMaster Osteoarthritis Index (WOMAC) scores. Statistical analysis included a mixed linear model evaluating for independent associations between the index knee FC and contralateral knee outcome measures.

      Results

      A knee FC was associated with a contralateral knee FC (P<.001) with contralateral FC severity dependent on severity of the index knee FC (P<.001). Participants at risk of developing OA with moderate FC showed worse function in the contralateral knee than those with mild FC (WOMAC functional subscale ± SD: 7.6±10.1 vs 5.5±8.8; P=.036). Mixed linear analysis confirmed an independent association between knee FC severity and contralateral WOMAC function.

      Conclusions

      Having an FC in 1 knee was associated with an FC in the contralateral knee for participants who were at risk of developing OA and for those with a current diagnosis of OA. For those at risk of developing OA, the severity of knee FC was an independent predictor for loss of contralateral knee function. Rehabilitation of patients with or at risk of developing OA should consider the restoration of extension and function for both knees.

      Keywords

      List of abbreviations:

      BMI (body mass index), FC (flexion contracture), KL (Kellgren and Lawrence Radiographic Osteoarthritis Grade), LLS (leg-length shortening), OA (osteoarthritis), OAI (Osteoarthritis Initiative Database), PASE (Physical Activity Scale for the Elderly), PNF (proprioceptive neuromuscular facilitation), ROM (range of motion), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
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      References

        • Hunter D.J.
        • Felson D.T.
        Osteoarthritis.
        BMJ. 2006; 332: 639-642
        • Molloy M.G.
        • Molloy C.B.
        Contact sport and osteoarthritis.
        Br J Sports Med. 2011; 45: 275-277
        • Cinque M.E.
        • Dornan G.J.
        • Chahla J.
        • Moatshe G.
        • LaPrade R.F.
        High rates of osteoarthritis develop After anterior cruciate ligament surgery: an analysis of 4108 patients.
        Am J Sports Med. 2018; 46: 2011-2019
        • Papalia R.
        • Vasta S.
        • Franceschi F.
        • D'Adamio S.
        • Maffulli N.
        • Denaro V.
        Meniscal root tears: from basic science to ultimate surgery.
        Br Med Bull. 2013; 106: 91-115
        • Majewski M.
        • Susanne H.
        • Klaus S.
        Epidemiology of athletic knee injuries: a 10-year study.
        Knee. 2006; 13: 184-188
        • Silverwood V.
        • Blagojevic-Bucknall M.
        • Jinks C.
        • Jordan J.L.
        • Protheroe J.
        • Jordan K.P.
        Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis.
        Osteoarthritis Cartilage. 2015; 23: 507-515
        • Shelbourne K.D.
        • Biggs A.
        • Gray T.
        Deconditioned knee: the effectiveness of a rehabilitation program that restores normal knee motion to improve symptoms and function.
        N Am J Sports Phys Ther. 2007; 2: 81-89
        • Campbell T.M.
        • Trudel G.
        • Laneuville O.
        Knee flexion contractures in patients with osteoarthritis: clinical features and histologic characterization of the posterior capsule.
        PM R. 2015; 7: 466-473
        • Norkin C.C.
        • White D.J.
        Measurement of joint motion: a guide to goniometry.
        FA Davis Company, Philadelphia2003
        • Murphy M.T.
        The effect of knee flexion contracture following total knee arthroplasty on the energy cost of walking.
        J Arthroplasty. 2014; 29: 85-89
        • Lee C.S.
        • Park S.J.
        • Chung S.S.
        • Lee K.H.
        The effect of simulated knee flexion on sagittal spinal alignment: novel interpretation of spinopelvic alignment.
        Eur Spine J. 2013; 22: 1059-1065
        • Murata Y.
        • Takahashi K.
        • Yamagata M.
        • Hanaoka E.
        • Moriya H.
        The knee-spine syndrome. Association between lumbar lordosis and extension of the knee.
        J Bone Joint Surg Br. 2003; 85: 95-99
        • Hochberg M.C.
        • Altman R.D.
        • April K.T.
        • et al.
        American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.
        Arthritis Care Res (Hoboken). 2012; 64: 465-474
        • McAlindon T.E.
        • Bannuru R.R.
        • Sullivan M.C.
        • et al.
        OARSI guidelines for the non-surgical management of knee osteoarthritis.
        Osteoarthritis Cartilage. 2014; 22: 363-388
        • Steultjens M.P.
        • Dekker J.
        • van Baar M.E.
        • Oostendorp R.A.
        • Bijlsma J.W.
        Range of joint motion and disability in patients with osteoarthritis of the knee or hip.
        Rheumatology (Oxford). 2000; 39: 955-961
        • Nevitt M.C.
        • Felson D.T.
        • Lester G.
        The osteoarthritis initiative - protocol for the cohort study.
        National Institutes of Health, Bethesda2006
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 494-502
        • Ritter M.A.
        • Lutgring J.D.
        • Davis K.E.
        • Berend M.E.
        • Pierson J.L.
        • Meneghini R.M.
        The role of flexion contracture on outcomes in primary total knee arthroplasty.
        J Arthroplasty. 2007; 22: 1092-1096
        • Magee D.J.
        Orthopedic physical assessment.
        5th ed. Saunders, Philadelphia2008
        • Loudon J.K.
        • Goist H.L.
        • Loudon K.L.
        Genu recurvatum syndrome.
        J Orthop Sports Phys Ther. 1998; 27: 361-367
        • Rodriguez-Merchan E.C.
        Knee instruments and rating scales designed to measure outcomes.
        J Orthop Traumatol. 2012; 13: 1-6
        • Washburn R.A.
        • Smith K.W.
        • Jette A.M.
        • Janney C.A.
        The Physical Activity Scale for the Elderly (PASE): development and evaluation.
        J Clin Epidemiol. 1993; 46: 153-162
        • Felson D.T.
        Central reading of knee x-rays for Kellgren and Lawrence grade and individual radiographic features of tibiofemoral knee OA.
        (Available at:)
        • Riddle D.L.
        • Jiranek W.A.
        • Hull J.R.
        Validity and reliability of radiographic knee osteoarthritis measures by arthroplasty surgeons.
        Orthopedics. 2013; 36: e25-32
      1. OAI Version 0.2.2 11/12/2008: Contents of AllClinical00. Available at: https://www.oarsijournal.com/cms/10.1016/j.joca.2018.08.003/attachment/0861c8ab-0dfb-4d2a-833e-ee3e42e9d8af/mmc2.pdf. Accessed January 27, 2020.

        • White D.K.
        • Keysor J.J.
        • Lavalley M.P.
        • et al.
        Clinically important improvement in function is common in people with or at high risk of knee OA: the MOST study.
        J Rheumatol. 2010; 37: 1244-1251
        • Barr A.J.
        • Campbell T.M.
        • Hopkinson D.
        • Kingsbury S.R.
        • Bowes M.A.
        • Conaghan P.G.
        A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis.
        Arthritis Res Ther. 2015; 25: 228
        • Felson D.T.
        • Zhang Y.
        • Hannan M.T.
        • et al.
        Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study.
        Arthritis Rheum. 1997; 40: 728-733
        • Khamis S.
        • Carmeli E.
        A new concept for measuring leg length discrepancy.
        J Orthop. 2017; 14: 276-280
        • Campbell T.M.
        • Ghaedi B.B.
        • Tanjong Ghogomu E.
        • Welch V.
        Shoe lifts for leg length discrepancy in adults with common painful musculoskeletal conditions: a systematic review of the literature.
        Arch Phys Med Rehabil. 2018; 99: 981-993
        • Hildebrand K.A.
        • Zhang M.
        • Hart D.A.
        Myofibroblast upregulators are elevated in joint capsules in posttraumatic contractures.
        Clin Orthop Relat Res. 2007; 456: 85-91
        • Campbell T.M.
        • Trudel G.
        • Wong K.K.
        • Laneuville O.
        Genome-wide gene expression analysis of the posterior capsule in patients with osteoarthritis and knee flexion contracture.
        J Rheumatol. 2014; 41: 2232-2239
        • Laneuville O.
        • Zhou J.
        • Uhthoff H.K.
        • Trudel G.
        Genetic influences on joint contractures secondary to immobilization.
        Clin Orthop Relat Res. 2007; 456: 36-41
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • Ekdahl C.
        • Beynnon B.D.
        Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28: 88-96
        • Bellamy N.
        • Buchanan W.W.
        • Goldsmith C.H.
        • Campbell J.
        • Stitt L.W.
        Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.
        J Rheumatol. 1988; 15: 1833-1840
        • Koh I.J.
        • Chang C.B.
        • Kang Y.G.
        • Seong S.C.
        • Kim T.K.
        Incidence, predictors, and effects of residual flexion contracture on clinical outcomes of total knee arthroplasty.
        J Arthroplasty. 2013; 28: 585-590
        • Campbell T.M.
        • Dudek N.
        • Trudel G.
        Joint contractures.
        in: Frontera W.R. Silver J. Rizzo T.D. Essentials of physical medicine and rehabilitation. 3rd ed. Saunders, Philadelphia2015: 648-649
        • Riddle D.L.
        • Kong X.
        • Jiranek W.A.
        Factors associated with rapid progression to knee arthroplasty: complete analysis of three-year data from the osteoarthritis initiative.
        Joint Bone Spine. 2012; 79: 298-303
        • Harvey L.A.
        • Katalinic O.M.
        • Herbert R.D.
        • Moseley A.M.
        • Lannin N.A.
        • Schurr K.
        Stretch for the treatment and prevention of contractures.
        Cochrane Database Syst Rev. 2017; 1: CD007455
        • Meena V.
        • Shanthi C.
        • Madhavi K.
        Effectiveness of PNF stretching versus static stretching on pain and hamstring slexibility following moist heat in individuals with knee osteoarthritis.
        Int J Physiother. 2016; 3: 529-534
        • Weng M.C.
        • Lee C.L.
        • Chen C.H.
        • et al.
        Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis.
        Kaohsiung J Med Sci. 2009; 25: 306-315
        • Aoki S.
        • Tsumura N.
        • Kimura A.
        • Okuyama S.
        • Takikawa S.
        • Hirata S.
        Home stretching exercise is effective for improving knee range of motion and gait in patients with knee osteoarthritis.
        J Phys Ther Sci. 2009; 21: 113-119