| Author: | Huang, Chen |
| Title: | The relationships between joint alignment, muscle properties, pain, and gait biomechanics in seniors with knee osteoarthritis |
| Advisors: | Fu, Siu Ngor (RS) |
| Degree: | Ph.D. |
| Year: | 2022 |
| Subject: | Osteoarthritis -- Patients Osteoarthritis -- Pathophysiology Knee -- Diseases Hong Kong Polytechnic University -- Dissertations |
| Department: | Department of Rehabilitation Sciences |
| Pages: | xvii, 152 pages : color illustrations |
| Language: | English |
| Abstract: | The aim of this project was to investigate the relationships between joint alignment, muscle properties, pain and joint biomechanics during walking in seniors with knee osteoarthritis (OA). Knee OA is one of the most common musculoskeletal disorders causing pain and functional limitations in the older population. It was suggested gait biomechanics in people with knee OA, including knee kinematics and kinetics, were related to the disease progression. Malalignment of the lower limb and quadriceps deficits were proposed to be contributing factors that might affect both knee kinematics and kinetics, and therefore induce excessive loading on the knee joint. Comprehensive understanding of knee joint alignment and muscle functioning for control of knee biomechanics could enhance knowledge of pathogenesis of knee OA and underpin rehabilitation for those with medial knee OA. This project comprised both cross-sectional observational and interventional studies on seniors with symptomatic and radiographic OA. The cross-sectional study involved 47 participants with the aim to explore (1) relationships between tibial torsion and joint loading; (2) association between joint alignment, muscle properties, and knee kinematics during walking; and (3) relationships between knee joint loading and pain. The associations between exercise-induced modulations on joint biomechanics, intensity of pain, and muscle properties were studied based on an interventional study in 39 participants. The hypotheses for this project were (1) tibial torsion in addition to knee varus angle was related to early stance phase joint biomechanics; (2) passive quadriceps muscle tension and strength would be associated with early stance phase knee sagittal kinematics; (3) pain intensity would be related to joint loading; (4) Six weeks of exercise-based rehabilitation program could modulate knee joint load and pain intensity, which would be related to changes in muscle functioning and sagittal knee kinematics during early stance phase of gait. In Chapter 2, the associations between lower limb alignments, quadriceps muscle properties, knee joint biomechanics in early stance phase of gait cycle in participants with knee OA are reported. Joint alignment along both frontal and sagittal planes were captured and quantified in a weight-bearing position using a bi-planar low-dose x-ray system. Passive muscle tensions of the superficial heads of the quadriceps muscle were captured using an ultrasound shear-wave elastography system and the maximal quadriceps strength by a handheld dynamometer. Joint kinetics and kinematics were captured during the early stance phase of gait cycle using a motion analysis system. Findings from the study indicated participants with moderate OA with larger external tibial torsion had larger external knee adduction moment (KAM) and showed a larger KAM index. Similarly, participants with moderate OA showed a negative association between external tibia torsion and knee flexion excursion; however, in mild knee OA, smaller knee flexion excursion was accompanied by greater passive tension of vastus lateralis. Such observations indicated that the associations between lower limb alignment, quadriceps muscle properties and knee biomechanics were OA severity specific. In mild OA, quadriceps properties, high passive tension of vastus lateralis, had stronger association with smaller knee flexion excursion; in moderate OA, it was external tibial torsion that had stronger association with more limited knee flexion and higher joint loading. In Chapter 3, the relationships between early stance knee joint loading and pain are reported. A path analysis model was used to assess possible relationships between joint loading and knee pain intensity. The model indicated that KAM had an indirect effect on pain intensity through the mediation of external knee flexion moment (KFM). Higher KAM was associated with lower pain intensity when KFM was positively related to pain. A negative relationship was established between KAM index and pain intensity. Therefore, the intensity of OA-related knee pain was related to loading along the frontal plane as well as the load sharing between the frontal and sagittal planes. In Chapter 4, findings from the interventional study to assess exercise-induced modulation on knee joint biomechanics, muscle properties, intensity of knee pain, and symptoms are presented. After a six-week exercise-based rehabilitation program, an increase in KAM was found to be associated with reduction in pain intensity. An increase in KAM index was related to improvement in pain and symptom. Reduced vastus lateralis passive tension was associated with an increase in knee flexion excursion in participants with mild knee OA. These findings further supported the observations from the cross-sectional study that OA-related pain intensity and joint biomechanics were linked; passive muscle tension of quadriceps lateral head and knee flexion excursion during loading response phase was realted to an earlier stage of knee OA. In summary, this project has revealed evidence that joint alignment, muscle properties, pain intensity, and knee gait biomechanics were linked in people with knee OA. The present study provided new evidence that (1) torsional alignment and quadriceps passive tension were linked with joint biomechanics during gait, and these links were specific to disease severity; (2) load sharing between the frontal and sagittal planes was related to pain intensity and symptoms. The knee loading re-distribution from frontal plane to sagittal plane was identified as an important biomechanical factor that had a strong link not only to improvement of pain but also to knee symptoms improvement. These findings provide insight into the pathomechanical pathway of knee OA and contribute to our understanding of muscle properties in the gait biomechanics of the knee joint. Such information might provide insights for rehabilitative strategies for knee OA. |
| Rights: | All rights reserved |
| Access: | open access |
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