| Author: | Li, Zongpan |
| Title: | The role of quadriceps properties and knee biomechanics in the development of clinical knee osteoarthritis |
| Advisors: | Fu, Siu-ngor (RS) |
| Degree: | Ph.D. |
| Year: | 2023 |
| Subject: | Quadriceps muscle Biomechanics Osteoarthritis Knee -- Diseases Hong Kong Polytechnic University -- Dissertations |
| Department: | Department of Rehabilitation Sciences |
| Pages: | xx, 170 pages : color illustrations |
| Language: | English |
| Abstract: | Quadriceps weakness has been a known contributing risk factor for the development of radiographic and symptomatic knee osteoarthritis (OA). As muscle performance relies on both active and passive components, passive quadriceps stiffness may also be a factor affecting the development of knee OA. Moreover, knee OA has been suggested to be a disease with primarily mechanical origins, thus altered knee biomechanics have been proposed as factors related to the initiation of knee OA. However, there is limited evidence from prospective studies for such causal relationships. Therefore, the aim of this project was to investigate the role of quadriceps properties and knee biomechanics in the development of clinical knee OA. This project involved two prospective and one cross-sectional observational studies. Study one examined associations between passive stiffness and strength of the quadriceps and the development of clinical knee OA in 12 months. A total of 162 eligible participants (aged 60–80 years) without knee pain were recruited from the local communities. At baseline, passive stiffness of three superficial quadriceps heads (rectus femoris [RF], vastus lateralis [VL], and vastus medialis oblique [VMO]) and quadriceps isokinetic strength were measured using shear-wave ultrasound elastography and Cybex dynamometer, respectively. Incidence of clinical knee OA and knee pain were defined based on clinical criteria at a 12-month visit. We found that greater passive stiffness and lower strength of the quadriceps were significantly associated with the development of clinical knee OA in 12 months. These findings suggest that the passive property and strength of the quadriceps may both be factors related to the development of clinical knee OA. Study two examined whether baseline knee biomechanics would predict the development of knee pain and clinical knee OA in 12 and 24 months. All the 162 older adults without painful knee completed gait analysis at baseline, for the computations of knee adduction and flexion moments (KAM and KFM), peak knee flexion angle and knee flexion excursion, and knee sagittal dynamic joint stiffness (DJS) during the loading response phase of gait. Incidences of clinical knee OA and knee pain were defined using clinical assessments and telephone survey. The results showed that the greater DJS was associated with a higher risk of developing clinical knee OA; and a higher KFM was associated with a lower risk of developing knee pain in 24 months. In addition, there was a trend showing a higher KAM was related to a higher risk of developing knee pain. However, knee flexions were not significant predictors for the developments of clinical knee OA or knee pain. These findings suggest that a greater DJS may be a potential risk factor and a higher KFM may be a potential protective factor for the development of knee symptoms in the aging population. Study three was a cross-sectional observation and delineated the relationships between quadriceps properties and patellar alignment, which is a known OA-related factor. We recruited 174 participants (aged 60–80 years), 92 of whom had knee pain. Magnetic resonance imaging was performed to measure patellar alignment (bisect offset, patellar tilt angle, and Insall-Salvati ratio). The findings from this study indicated that (1) lateral patellar displacement/tilt was associated with higher VL stiffness and lower quadriceps strength; (2) higher patellar riding position was correlated with higher VMO stiffness; and (3) higher VL/VMO stiffness ratio was associated with larger lateral patellar displacement in people with painful knee. These findings suggest that the passive stiffness and general strength of the quadriceps may both be factors related to patellar alignments. These findings could provide preliminary evidence for future studies with prospective mediation design to examine whether altered quadriceps properties would be associated with the risk of knee OA/symptom, by affecting patellar alignments. This project identified new potential factors related to the development of OA-related knee symptoms in the aging population: (i) two potential risk factors: increased quadriceps passive stiffness and greater sagittal knee dynamic joint stiffness; (ii) two potential protective factors: higher quadriceps strength and greater knee flexion moment. The direct relationships between quadriceps properties and patellar alignments were established. This may indicate a potential direction for future study with mediation design to explore the mechanism on how quadriceps properties would contribute to the development of knee OA/symptoms. Moreover, the findings from the present project may provide basis for further clinical trials to examine whether the manipulations on those factors would be beneficial for maintaining good knee health for the elderly. |
| Rights: | All rights reserved |
| Access: | open access |
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