Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis

Foroughi, Nasim; Smith, Richard M.; Lange, Angela K.; Baker, Michael K.; Singh, Maria A. Fiatarone; Vanwanseele, Benedicte

doi:10.1016/j.knee.2009.09.006

« Previous Next »The Knee
Volume 17, Issue 3 , Pages 210-216, June 2010

Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis

Nasim Foroughi
- Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
- Corresponding author. Exercise, Health and Performance Research Group, Faculty of Health Science, University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia. Tel.: +61 433 663 590; fax: +61 2 9351 9204.
Richard M. Smith
- Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
Angela K. Lange
- Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
Michael K. Baker
- Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
Maria A. Fiatarone Singh
- Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Centre on Aging at Tufts University, Boston, MA, USA
Benedicte Vanwanseele
- Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia

Received 22 June 2009; received in revised form 10 September 2009; accepted 26 September 2009. published online 09 November 2009.

Abstract

Lower limb dynamic alignment represents the limb position during functional loading conditions and obtains valuable information throughout the gait cycle rather than a single instant in time. This study aims to determine whether dynamic alignment is altered in medial knee osteoarthritis (OA) and how dynamic alignment is related to knee adduction moment (KAM). Community-dwelling women (n=17) with medial OA in at least one knee, according to the American College of Rheumatology criteria and 17 body mass index-matched women without OA were recruited. A three-dimensional motion analysis system was used to collect the gait data at self-selected habitual and maximal speeds. Clinical evaluation of lower extremities, physical function, pain, habitual level of physical activity, quality of life and physical self-efficacy were assessed. Shank adduction angle and shank mean angular velocity were significantly greater in the OA group compared to the controls from heel strike to 30% stance. KAM was not different between the groups (p=0.542). Dynamic alignment variables were the best predictors of KAM. Health-related quality of life, habitual level of physical activity, lower extremity muscle strength and balance performance were impaired in the OA group compared to the controls. The importance of variables that contribute to dynamic alignment and the contribution of limb alignment to KAM were highlighted in this study. Detection of postural changes such as altered dynamic alignment in early stages of OA will lead to the institution of joint-protective measures including changes in footwear, orthotics, gait re-training, use of assistive devices to reduce weight-bearing loads, strengthening and balance enhancing exercises, better analgesia, or cartilage-preserving pharmacotherapy.

Keywords: Osteoarthritis, Angular velocity, Dynamic alignment, Knee adduction moment