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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 06, 2020
Footnotes
Supported by the Bruyère Academic Medical Organization Research Innovation Fund (grant no. BAM-16-001).
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
