Association Between Knee Joint Muscle Activation and Knee Joint Moment Patterns During Walking in Moderate Medial Compartment Knee Osteoarthritis: Implications for Secondary Prevention

  • Gillian L. Hatfield
    School of Kinesiology, University of the Fraser Valley, Chilliwack, British Columbia, Canada
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  • Kerry E. Costello
    Department of Physical Therapy & Athletic Training, Boston University, Boston, MA

    Section of Rheumatology, Boston University School of Medicine, Boston, MA
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  • Janie L. Astephen Wilson
    School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada

    Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada

    Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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  • William D. Stanish
    School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada

    Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Cheryl L. Hubley-Kozey
    Corresponding author Cheryl L. Hubley-Kozey, PhD, Dalhousie University, Schools of Physiotherapy and Biomedical Engineering, 5981 University Ave, Halifax, NS B3H 1W2, Canada.
    School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada

    School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada

    Department of Surgery, Affiliated Scientist Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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      To determine associations between knee moment features linked to osteoarthritis (OA) progression, gait muscle activation patterns, and strength.


      Cross-sectional secondary analysis.


      Gait laboratory.


      Convenience sample of 54 patients with moderate, medial knee OA (N=54).



      Main Outcome Measures

      Knee moments and quadriceps and hamstrings activation were examined during walking. Knee extensor and flexor strength were measured. Waveform patterns were extracted using principal component analysis. Each measured waveform was scored against principal components (PCs) that captured overall magnitude (PC1) and early to midstance difference (PC2) features, with higher PC2 scores interpreted as greater moment differential and more prolonged muscle activity. Correlations were calculated between moment PC scores and muscle PC and strength scores. Regression analyses determined moment PC score variance explained by muscle PC scores and strength.


      All correlations for knee adduction moment difference feature (KAMPC2) and prolonged muscle activity (PC2) were significant (r=−0.40 to −0.54). Knee flexion moment difference feature (KFMPC2) was significantly correlated with all quadriceps and medial hamstrings PC2 scores (r=−0.47 to −0.61) and medial hamstrings magnitude feature (PC1) (r=−0.52). KAMPC2 was significantly correlated with knee flexor strength (r=0.43), and KFMPC2 was significantly correlated with knee extensor (r=0.60) and flexor (r=0.55) strength. Regression models including muscle PC2 scores and knee flexor strength explained 46% of KAMPC2 variance, whereas muscle PC2 scores and knee extensor strength explained 59% of KFMPC2 variance.


      Muscle activation patterns and strength explained significant variance in moment difference features, highest for the knee flexion moment. This supports that exercises such as neuromuscular training, focused on appropriate muscle activation patterns, and strengthening have the potential to alter dynamic loading gait patterns associated with knee OA clinical progression.


      List of abbreviations:

      EMG (electromyography), KAM (knee adduction moment), KE (knee extensor), KF (knee flexor), KFM (knee flexion moment), LH (lateral hamstring), MH (medial hamstring), MVIC (maximum voluntary isometric contraction), OA (osteoarthritis), PC (principal component), PCA (principal component analysis), TKA (total knee arthroplasty), VL (vastus lateralis), VM (vastus medialis)
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