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. 2001 Jun;60(6):612–618. doi: 10.1136/ard.60.6.612

Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects

B Hassan 1, S Mockett 1, M Doherty 1
PMCID: PMC1753664  PMID: 11350851

Abstract

OBJECTIVES—To investigate whether subjects with knee osteoarthritis (OA) have reduced static postural control, knee proprioceptive acuity, and maximal voluntary contraction (MVC) of the quadriceps compared with normal controls, and to determine possible independent predictors of static postural sway.
METHODS—77 subjects with symptomatic and radiographic knee OA (58 women, 19 men; mean age 63.4 years, range 36-82) and 63 controls with asymptomatic and clinically normal knees (45 women, 18 men; mean age 63 years, range 46-85) underwent assessment of static postural sway. 108 subjects (59 patients, 49 controls) also underwent assessment of knee proprioceptive activity and MVC (including calculation of quadriceps activation). In patients with knee OA knee pain, stiffness, and functional disability were assessed using the WOMAC Index. The height (m) and weight (kg) of all subjects was assessed.
RESULTS—Compared with controls, patients with knee OA were heavier (mean difference 15.3 kg, p<0.001), had increased postural lateral sway (controls: median 2.3, interquartile (IQ) range 1.8-2.9; patients: median 4.7, IQ range 1.9-4.7, p<0.001), reduced proprioceptive acuity (controls: mean 7.9, 95% CI 6.9 to 8.9; patients: mean 12.0, 95% CI 10.5 to 13.6, p<0.001), weaker quadriceps strength (controls: mean 22.5, 95% CI 19.9 to 24.6; patients: mean 14.7, 95% CI 12.5 to 16.9, p<0.001), and less percentage activation of quadriceps (controls: mean 87.4, 95% CI 80.7 to 94.2; patients: mean 66.0, 95% CI 58.8 to 73.2, p<0.001). The significant predictors of postural sway were knee pain and the ratio of MVC/body weight.
CONCLUSIONS—Compared with age and sex matched controls, subjects with symptomatic knee OA have quadriceps weakness, reduced knee proprioception, and increased postural sway. Pain and muscle strength may particularly influence postural sway. The interaction between physiological, structural, and functional abnormalities in knee OA deserves further study.



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Figure 1  .

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Box plots showing postural lateral sway in controls (n=63) and patients (n=77).

Figure 2  .

Figure 2  

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Postural sway in anteroposterior direction on right foot (AP Right) and left foot (AP Left) for controls (n =63), and patients (n=77).

Figure 3  .

Figure 3  

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Proprioceptive acuity (degrees) for controls (n=54) and patients (n=66).

Figure 4  .

Figure 4  

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Maximal voluntary contraction for controls (n=49) and patients (n=59).

Figure 5  .

Figure 5  

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Percentage quadriceps activation for controls (n=47) and patients (n=57).

Selected References

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  1. Assimakopoulos A. P., Katonis P. G., Agapitos M. V., Exarchou E. I. The innervation of the human meniscus. Clin Orthop Relat Res. 1992 Feb;(275):232–236. [PubMed] [Google Scholar]
  2. Barrett D. S., Cobb A. G., Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Joint Surg Br. 1991 Jan;73(1):53–56. doi: 10.1302/0301-620X.73B1.1991775. [DOI] [PubMed] [Google Scholar]
  3. Bellamy N., Buchanan W. W., Goldsmith C. H., Campbell J., Stitt L. W. 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 Dec;15(12):1833–1840. [PubMed] [Google Scholar]
  4. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  5. Brucini M., Duranti R., Galletti R., Pantaleo T., Zucchi P. L. Pain thresholds and electromyographic features of periarticular muscles in patients with osteoarthritis of the knee. Pain. 1981 Feb;10(1):57–66. doi: 10.1016/0304-3959(81)90045-2. [DOI] [PubMed] [Google Scholar]
  6. Davis M. A., Ettinger W. H., Neuhaus J. M., Mallon K. P. Knee osteoarthritis and physical functioning: evidence from the NHANES I Epidemiologic Followup Study. J Rheumatol. 1991 Apr;18(4):591–598. [PubMed] [Google Scholar]
  7. Del Valle M. E., Harwin S. F., Maestro A., Murcia A., Vega J. A. Immunohistochemical analysis of mechanoreceptors in the human posterior cruciate ligament: a demonstration of its proprioceptive role and clinical relevance. J Arthroplasty. 1998 Dec;13(8):916–922. doi: 10.1016/s0883-5403(98)90199-1. [DOI] [PubMed] [Google Scholar]
  8. Henry S. M., Fung J., Horak F. B. EMG responses to maintain stance during multidirectional surface translations. J Neurophysiol. 1998 Oct;80(4):1939–1950. doi: 10.1152/jn.1998.80.4.1939. [DOI] [PubMed] [Google Scholar]
  9. Holme E., Magnusson S. P., Becher K., Bieler T., Aagaard P., Kjaer M. The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sports. 1999 Apr;9(2):104–109. doi: 10.1111/j.1600-0838.1999.tb00217.x. [DOI] [PubMed] [Google Scholar]
  10. Hurley M. V., Newham D. J. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early, unilateral osteoarthritic knees. Br J Rheumatol. 1993 Feb;32(2):127–131. doi: 10.1093/rheumatology/32.2.127. [DOI] [PubMed] [Google Scholar]
  11. Hurley M. V., Rees J., Newham D. J. Quadriceps function, proprioceptive acuity and functional performance in healthy young, middle-aged and elderly subjects. Age Ageing. 1998 Jan;27(1):55–62. doi: 10.1093/ageing/27.1.55. [DOI] [PubMed] [Google Scholar]
  12. Hurley M. V., Scott D. L., Rees J., Newham D. J. Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis. 1997 Nov;56(11):641–648. doi: 10.1136/ard.56.11.641. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kaplan F. S., Nixon J. E., Reitz M., Rindfleish L., Tucker J. Age-related changes in proprioception and sensation of joint position. Acta Orthop Scand. 1985 Feb;56(1):72–74. doi: 10.3109/17453678508992984. [DOI] [PubMed] [Google Scholar]
  14. Kavounoudias A., Gilhodes J. C., Roll R., Roll J. P. From balance regulation to body orientation: two goals for muscle proprioceptive information processing? Exp Brain Res. 1999 Jan;124(1):80–88. doi: 10.1007/s002210050602. [DOI] [PubMed] [Google Scholar]
  15. Lanyon P., O'Reilly S., Jones A., Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis. 1998 Oct;57(10):595–601. doi: 10.1136/ard.57.10.595. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Maki B. E., Perry S. D., Norrie R. G., McIlroy W. E. Effect of facilitation of sensation from plantar foot-surface boundaries on postural stabilization in young and older adults. J Gerontol A Biol Sci Med Sci. 1999 Jun;54(6):M281–M287. doi: 10.1093/gerona/54.6.m281. [DOI] [PubMed] [Google Scholar]
  17. Marks R., Quinney H. A., Wessel J. Proprioceptive sensibility in women with normal and osteoarthritic knee joints. Clin Rheumatol. 1993 Jun;12(2):170–175. doi: 10.1007/BF02231522. [DOI] [PubMed] [Google Scholar]
  18. Martel-Pelletier J. Pathophysiology of osteoarthritis. Osteoarthritis Cartilage. 1998 Nov;6(6):374–376. doi: 10.1053/joca.1998.0140. [DOI] [PubMed] [Google Scholar]
  19. McAlindon T. E., Cooper C., Kirwan J. R., Dieppe P. A. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993 Apr;52(4):258–262. doi: 10.1136/ard.52.4.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. McAlindon T. E., Cooper C., Kirwan J. R., Dieppe P. A. Knee pain and disability in the community. Br J Rheumatol. 1992 Mar;31(3):189–192. doi: 10.1093/rheumatology/31.3.189. [DOI] [PubMed] [Google Scholar]
  21. Nordesjö L. O., Nordgren B., Wigren A., Kolstad K. Isometric strength and endurance in patients with severe rheumatoid arthritis or osteoarthrosis in the knee joints. A comparative study in healthy men and women. Scand J Rheumatol. 1983;12(2):152–156. doi: 10.3109/03009748309102902. [DOI] [PubMed] [Google Scholar]
  22. O'Reilly S. C., Jones A., Muir K. R., Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998 Oct;57(10):588–594. doi: 10.1136/ard.57.10.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Petrella R. J., Lattanzio P. J., Nelson M. G. Effect of age and activity on knee joint proprioception. Am J Phys Med Rehabil. 1997 May-Jun;76(3):235–241. doi: 10.1097/00002060-199705000-00015. [DOI] [PubMed] [Google Scholar]
  24. Rutherford O. M., Jones D. A., Newham D. J. Clinical and experimental application of the percutaneous twitch superimposition technique for the study of human muscle activation. J Neurol Neurosurg Psychiatry. 1986 Nov;49(11):1288–1291. doi: 10.1136/jnnp.49.11.1288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Schutte M. J., Dabezies E. J., Zimny M. L., Happel L. T. Neural anatomy of the human anterior cruciate ligament. J Bone Joint Surg Am. 1987 Feb;69(2):243–247. [PubMed] [Google Scholar]
  26. Skinner H. B., Barrack R. L., Cook S. D. Age-related decline in proprioception. Clin Orthop Relat Res. 1984 Apr;(184):208–211. [PubMed] [Google Scholar]
  27. Sutton A. J., Muir K. R., Jones A. C. Two knees or one person: data analysis strategies for paired joints or organs. Ann Rheum Dis. 1997 Jul;56(7):401–402. doi: 10.1136/ard.56.7.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Szturm T., Fallang B. Effects of varying acceleration of platform translation and toes-up rotations on the pattern and magnitude of balance reactions in humans. J Vestib Res. 1998 Sep-Oct;8(5):381–397. [PubMed] [Google Scholar]
  29. Wegener L., Kisner C., Nichols D. Static and dynamic balance responses in persons with bilateral knee osteoarthritis. J Orthop Sports Phys Ther. 1997 Jan;25(1):13–18. doi: 10.2519/jospt.1997.25.1.13. [DOI] [PubMed] [Google Scholar]
  30. Winter D. A., Patla A. E., Frank J. S. Assessment of balance control in humans. Med Prog Technol. 1990 May;16(1-2):31–51. [PubMed] [Google Scholar]

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