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Effect of anatomic realignment on muscle function during gait in patients with medial compartment knee osteoarthritis†
Article first published online: 29 MAR 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 3, pages 389–397, 15 April 2007
How to Cite
Ramsey, D. K., Snyder-Mackler, L., Lewek, M., Newcomb, W. and Rudolph, K. S. (2007), Effect of anatomic realignment on muscle function during gait in patients with medial compartment knee osteoarthritis. Arthritis & Rheumatism, 57: 389–397. doi: 10.1002/art.22608
- Issue published online: 29 MAR 2007
- Article first published online: 29 MAR 2007
- Manuscript Accepted: 21 JUL 2006
- Manuscript Received: 10 FEB 2006
- National Center for Research Resources. Grant Number: P20-RR-016458
- NIH. Grant Numbers: T32-HD-007490, R01-HD-037985, R01-AR-048212
- Knee osteoarthritis;
Individuals with medial compartment knee osteoarthritis (OA) and genu varum use different movement and muscle activation patterns to increase joint stability during gait. The purpose of this study was to ascertain whether opening-wedge high-tibial osteotomy (OW-HTO) corrected pathomechancial abnormalities associated with the progression of knee OA.
Fifteen patients diagnosed with medial knee OA and genu varum who were scheduled for OW-HTO were tested prior to and 1 year following OW-HTO. Fifteen age- and sex-matched controls were also tested. Frontal plane laxity was measured from stress radiographs. All participants underwent quadriceps strength testing with a burst superimposition technique and gait analysis with surface electromyography to calculate knee joint kinematics and kinetics and muscle co-contraction during the stance phase of gait. Participants rated their knee function and instability using a self-report questionnaire.
Static alignment improved following the surgery. Medial laxity (P = 0.003) and instability (P = 0.002) significantly improved, and statistical reductions in the adduction moment resulted in lower levels of vastus medialis-medial gastrocnemius muscle co-contractions (P = 0.089). Despite improvements in global rating of knee function (P = 0.001), the OA group's ratings remained significantly lower than those of the healthy controls (P = 0.001). Quadriceps strength deficits and knee flexion impairments persisted.
Persistent quadriceps weakness and impaired knee kinematics after realignment suggest that the movement strategy may perpetuate joint destruction and impede the long-term success of realignment. Rehabilitation should focus on quadriceps strength and improving joint mobility to improve the long-term function of individuals with medial knee OA.