Advertisement

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
    Affiliations
    School of Kinesiology, University of the Fraser Valley, Chilliwack, British Columbia, Canada
    Search for articles by this author
  • Kerry E. Costello
    Affiliations
    Department of Physical Therapy & Athletic Training, Boston University, Boston, MA

    Section of Rheumatology, Boston University School of Medicine, Boston, MA
    Search for articles by this author
  • Janie L. Astephen Wilson
    Affiliations
    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
    Search for articles by this author
  • William D. Stanish
    Affiliations
    School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada

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

      Abstract

      Objective

      To determine associations between knee moment features linked to osteoarthritis (OA) progression, gait muscle activation patterns, and strength.

      Design

      Cross-sectional secondary analysis.

      Setting

      Gait laboratory.

      Participants

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

      Interventions

      None.

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

      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)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hunter DJ
        • Schofield D
        • Callander E.
        The individual and socioeconomic impact of osteoarthritis.
        Nat Rev Rheumatol. 2014; 10: 437-441
        • King LK
        • Kendzerska T
        • Waugh EJ
        • Hawker GA.
        Impact of osteoarthritis on difficulty walking: a population-based study.
        Arthritis Care Res (Hoboken). 2018; 70: 71-79
        • King LK
        • Marshall DA
        • Faris P
        • et al.
        Use of recommended non-surgical knee osteoarthris management in patients prior to total knee arthroplasty: a cross-sectional study.
        J Rheumatol. 2020; 47: 1253-1260
        • Gossec L
        • Paternotte S
        • 3rd Bingham CO
        • et al.
        OARSI/OMERACT initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis. an OMERACT 10 special interest group.
        J Rheumatol. 2011; 38: 1765-1769
        • Brandt KD
        • Radin EL
        • Dieppe PA
        • van de Putte L.
        Yet more evidence that osteoarthritis is not a cartilage disease.
        Ann Rheum Dis. 2006; 65: 1261-1264
        • Deluzio KJ
        • Astephen JL.
        Biomechanical features of gait waveform data associated with knee osteoarthritis: an application of principal component analysis.
        Gait Posture. 2007; 25: 86-93
        • Landry SC
        • McKean KA
        • Hubley-Kozey CL
        • Stanish WD
        • Deluzio KJ.
        Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed.
        J Biomech. 2007; 40: 1754-1761
        • Astephen JL
        • Deluzio KJ
        • Caldwell GE
        • Dunbar MJ.
        Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity.
        J Orthop Res. 2008; 26: 332-341
        • Zeni JA
        • Higginson JS.
        Differences in gait parameters between healthy subjects and persons with moderate and severe knee osteoarthritis: a result of altered walking speed?.
        Clin Biomech (Bristol, Avon). 2009; 24: 372-378
        • Hatfield GL
        • Stanish WD
        • Hubley-Kozey CL.
        Three-dimensional biomechanical gait characteristics at baseline are associated with progression to total knee arthroplasty.
        Arthritis Care Res (Hoboken). 2015; 67: 1004-1014
        • Bennell KL
        • Bowles KA
        • Wang Y
        • Cicuttini F
        • Davies-Tuck M
        • Hinman RS.
        Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis.
        Ann Rheum Dis. 2011; 70: 1770-1774
        • Chehab EF
        • Favre J
        • Erhart-Hledik JC
        • Andriacchi TP.
        Baseline knee adduction and flexion moments during walking are both associated with 5 year cartilage changes in patients with medial knee osteoarthritis.
        Osteoarthritis Cartilage. 2014; 22: 1833-1839
        • Davis E
        • Hubley-Kozey CL
        • Landry SC
        • Ikeda DM
        • Stanish WD
        • Astephen Wilson JL
        Longitudinal evidence links joint level mechanics and muscle activation patterns to 3-year medial joint space narrowing.
        Clin Biomech (Bristol, Avon). 2019; 61: 233-239
        • Hatfield GL
        • Stanish WD
        • Hubley-Kozey CL.
        Relationship between knee adduction moment patterns extracted using principal component analysis and discrete measures with different amplitude normalizations: implications for knee osteoarthritis progression studies.
        Clin Biomech (Bristol, Avon). 2015; 30: 1146-1152
        • Miyazaki T
        • Wada M
        • Kawahara H
        • Sato M
        • Baba H
        • Shimada S.
        Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis.
        Ann Rheum Dis. 2002; 61: 617-622
        • Zhao D
        • Banks SA
        • Mitchell KH
        • D'Lima DD
        • Colwell CW
        • Fregly BJ
        Correlation between the knee adduction torque and medial contact force for a variety of gait patterns.
        J Orthop Res. 2007; 25: 789-797
        • Schipplein OD
        • Andriacchi TP.
        Interaction between active and passive knee stabilizers during level walking.
        J Orthop Res. 1991; 9: 113-119
        • Bennell KL
        • Hunt MA
        • Wrigley TV
        • Lim BW
        • Hinman RS.
        Role of muscle in the genesis and management of knee osteoarthritis.
        Rheum Dis Clin North Am. 2008; 34: 731-754
        • Winby CR
        • Lloyd DG
        • Besier TF
        • Kirk TB.
        Muscle and external load contribution to knee joint contact loads during normal gait.
        J Biomech. 2009; 42: 2294-2300
        • Hubley-Kozey CL
        • Deluzio KJ
        • Landry SC
        • McNutt JS
        • Stanish WD.
        Neuromuscular alterations during walking in persons with moderate knee osteoarthritis.
        J Electromyogr Kinesiol. 2006; 16: 365-378
        • Hubley-Kozey CL
        • Hill NA
        • Rutherford DJ
        • Dunbar MJ
        • Stanish WD.
        Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking.
        Clin Biomech (Bristol, Avon). 2009; 24: 407-414
        • Zeni JA
        • Rudolph K
        • Higginson JS.
        Alterations in quadriceps and hamstrings coordination in persons with medial compartment knee osteoarthritis.
        J Electromyogr Kinesiol. 2010; 20: 148-154
        • Hodges PW
        • van den Hoorn W
        • Wrigley TV
        • et al.
        Increased duration of co-contraction of medial knee muscles is associated with greater progression of knee osteoarthritis.
        Man Ther. 2016; 21: 151-158
        • Hatfield GL
        • Costello KE
        • Astephen Wilson JL
        • Stanish WD
        • Hubley-Kozey CL
        Baseline gait muscle activation patterns differ for osteoarthritis patients who undergo total knee arthroplasty 5-8 years later from those who do not.
        Arthritis Care Res (Hoboken). 2021; 73: 549-558
        • Costello KE
        • Astephen Wilson JL
        • Stanish WD
        • Urquhart N
        • Hubley-Kozey CL
        Differences in baseline joint moments and muscle activation patterns associated with knee osteoarthritis progression when defined using a clinical versus a structural outcome.
        J Appl Biomech. 2020; 36 ([Epub ahead of print]): 39-51https://doi.org/10.1123/jab.2019-0127
        • Horisberger M
        • Fortuna R
        • Valderrabana V
        • Herzog W.
        Long-term repetitive mechanical loading of the knee joint by in vivo muscle stimulation accelerates cartilage degeneration and increases chondrocyte death in a rabbit model.
        Clin Biomech (Bristol, Avon). 2013; 28: 536-543
        • Bennell KL
        • Kyriakides M
        • Metcalf B
        • et al.
        Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial.
        Arthritis Rheumatol. 2014; 66: 950-959
        • Foroughi N
        • Smith RM
        • Lange AK
        • Singh MA
        • Vanwanseele B.
        Progressive resistance training and dynamic alignment in osteoarthritis: a single-blind randomised controlled trial.
        Clin Biomech (Bristol, Avon). 2011; 26: 71-77
        • Thorstensson CA
        • Henriksson M
        • von Porat A
        • Sjodahl C
        • Roos EM.
        The effect of eight weeks of exercise on knee adduction moment in early knee osteoarthritis–a pilot study.
        Osteoarthritis Cartilage. 2007; 15: 1163-1170
        • Brenneman EC
        • Kuntz AB
        • Wiebenga EG
        • Maly MR.
        A yoga strengthening program designed to minimize the knee adduction moment for women with knee osteoarthritis: a proof-of-principle cohort study.
        PLoS One. 2015; 10e0136854
        • Brenneman EC
        • Maly MR.
        Identifying changes in gait waveforms following a strengthening intervention for women with knee osteoarthritis using principal components analysis.
        Gait Posture. 2018; 59: 286-291
        • Altman R
        • Asch E
        • Bloch D
        • et al.
        Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
        Arthritis Rheum. 1986; 29: 1039-1049
        • Scott WW
        • Lethbridge-Cejku M
        • Reichle R
        • Wigly FM
        • Tobin JD
        • Hochberg MC.
        Reliability of grading scales for individual radiographic features of osteoarthritis of the knee: the Baltimore longitudinal study of aging atlas of knee osteoarthritis.
        Invest Radiol. 1993; 28: 497-501
        • Bellamy N
        • Buchanan WW
        • Goldsmith CH
        • Campbell J
        • Stitt LW.
        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
        • Kellgren JH
        • Lawrence JS.
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 494-502
        • Hubley-Kozey CL
        • Robbins SM
        • Rutherford DJ
        • Stanish WD.
        Reliability of surface electromyographic recordings during walking in individuals with knee osteoarthritis.
        J Electromyogr Kinesiol. 2013; 23: 334-341
        • Robbins SM
        • Astephen Wilson JL
        • Rutherford DJ
        • Hubley-Kozey CL
        Reliability of principal components and discrete parameters of knee angle and moment gait waveforms in individuals with moderate knee osteoarthritis.
        Gait Posture. 2013; 38: 421-427
        • Brandon SC
        • Graham RB
        • Almosnino S
        • Sadler EM
        • Stevenson JM
        • Deluzio KJ.
        Interpreting principal components in biomechanics: representative extremes and single component reconstruction.
        J Electromyogr Kinesiol. 2013; 23: 1304-1310
        • Osborne JW
        • Costello AB.
        Sample size and subject to item ratio in principal components analysis.
        Pract Assess Res Evaluation. 2004; 9: 11
        • Chatterjee S
        • Hadi AS
        • Price B.
        3rd ed. Regression analysis by example. 104. Wiley, New York2000
        • Richards R
        • van den Noort JC
        • Dekker J
        • Harlaar J.
        Gait retraining with real-time biofeedback to reduce knee adduction moment: systematic review of effects and methods used.
        Arch Phys Med Rehabil. 2017; 98: 137-150
        • Petersen W
        • Ellermann A
        • Zantop T
        • et al.
        Biomechanical effect of unloader braces for medial osteoarthritis of the knee: a systematic review.
        Arch Orthop Trauma Surg. 2016; 136: 649-656
        • Arnold JB
        • Wong DX
        • Jones RK
        • Hill CL
        • Thewlis D.
        Lateral wedge insoles for reducing biomechanical risk factors for medial knee osteoarthritis progression: a systematic review and meta-analysis.
        Arthritis Care Res (Hoboken). 2016; 68: 936-951
        • Foroughi N
        • Smith R
        • Vanwanseele B.
        The association of external knee adduction moment with biomechanical variables in osteoarthritis: a systematic review.
        Knee. 2009; 16: 303-309
        • Foroughi N
        • Smith RM
        • Lange AK
        • Baker MK
        • Fiatarone Singh MA
        • Vanwanseele B
        Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis.
        Knee. 2010; 17: 210-216
        • Rutherford DJ
        • Hubley-Kozey CL
        • Stanish WD.
        Knee effusion affects knee mechanics and muscle activity during gait in individuals with knee osteoarthritis.
        Osteoarthritis Cartilage. 2012; 20: 974-981
        • Astephen Wilson JL
        • Stanish WD
        • Hubley-Kozey CL
        Asymptomatic and symptomatic individuals with the same radiographic evidence of knee osteoarthritis walk with different knee moments and muscle activity.
        J Orthop Res. 2017; 35: 1661-1670
        • van Tunen JA
        • Dell'Isola A
        • Juhl J
        • et al.
        Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis - a systematic review and meta-analysis.
        BMC Musculoskelet Disord. 2018; 19: 273
        • van der Esch M
        • Knoop J
        • van der Leeden M
        • et al.
        Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort.
        Clin Rheumatol. 2012; 31: 1505-1510
        • Jeong HS
        • Lee S
        • Jee H
        • Song JB
        • Chang HS
        • Lee SY.
        Proprioceptive training and outcomes of patients with knee osteoarthritis: a meta-analysis of randomized controlled trials.
        J Athl Train. 2019; 54: 418-428