Determinantes mecánicos de los momentos adductores externos de rodilla durante la marcha en población sana

  1. Javier Pascual Huerta
  2. Juan Manuel Ropa Moreno
  3. Ernesto Maceira Suárez 1
  4. Angel Manuel Orejana García 2
  5. Fermín Viejo Tirado 2
  1. 1 Complejo Hospitalario La Mancha Centro

    Complejo Hospitalario La Mancha Centro

    Alcázar de San Juan, España

  2. 2 Universidad Complutense de Madrid

    Universidad Complutense de Madrid

    Madrid, España

    ROR 02p0gd045

Revista española de podología

ISSN: 0210-1238

Year of publication: 2021

Volume: 32

Issue: 1

Pages: 18-26

Type: Article

DOI: 10.20986/REVESPPOD.2021.1599/2021 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Revista española de podología


Objectives: Frontal plane knee joint moments are used nowadays as an indirect measure of the load in the medial and lateral compartments of the joint. The present study tries to investigate mechanical factors that can have an influence in the increase of knee adduction joint moments during gait. Patients and methods: A computerized gait analysis was performed with seven videocameras and two force platforms to study kinematic and kinetic variables in healthy individuals. The graph of knee joint moments in the frontal plane was analyzed in three variables: maximum value during the first half and second half of contact phase and total area of the graph. Comparison between sex and a linear regression analysis with several mechanical factors was performed for those three variables. Results: 100 individuals were included the study (56 men and 44 women). No sex differences were found in the three variables analyzed. Factors with greater influence in knee joint moments were femorotibial alignment in static stance, frontal plane hip joint moments and tibial rotation during gait. Conclusions: Femorotibial alignment in the frontal plane was the main factor that contributes to load in medial and lateral compartments of the knee during gait. Abductor muscles contraction of he hip and tibial rotation were the other relevant mechanical factors found.

Bibliographic References

  • Andrews M, Noyes FR, Hewett TE, Andriacchi TP. Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: A critical analysis of the reliability of gait analysis data. J Orthop Res. 1996;14(2):289-95. DOI: 10.1002/jor.1100140218.
  • Andriacchi TP, Mündermann A, Smith RL, Alexander EJ, Dirby CO, Koo S. A framework for the in vivo pathomechanics of ostearthritis at the knee. An Biomed Engineering. 2004;32(3):447-57. DOI: 10.1023/B:A BME.0000017541.82498.37.
  • Andriacchi TP. Dynamics of knee malalignment. Orthop Clin North Am. 1994;25(3):395-403. DOI: 10.1016/S0030-5898(20)31924-6.
  • Asociación Médica Mundial AMM. Declaración de Helsinki de la AMM- Principios éticos para las investigaciones médicas en seres humanos. Disponible en: declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/ [citado: 27 Diciembre 2020].
  • Astephen JL, Deluzio KJ. Changes in frontal plane dynamics and the loading response phase of the gait cycle characteristic of severe knee ostearthritis application of a multidimensional analysis technique. Clin Biomech. 2005;20(2):209-17. DOI: 10.1016/j.clinbiomech.2004.09.007.
  • Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, Andriacchi TP. Increase knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis Cartilage. 2002;10(7):573-9. DOI: 10.1053/joca.2002.0797.
  • Carmona L, Ballina FJ, Gabriel R, Laffon A; EPISER Study Group. The burden of musculoeskeletal diseases in the general population of Spain: Results from a nation-wide study. Ann Rheum Dis. 2001;60(11):1040-5. DOI: 10.1136/ard.60.11.1040.
  • Chang A, Hayes K, Dunlop D, Hurwitz D, Song J, Cahue S, et al. Trust during ambulation and the progression of knee osteoarthritis. Arthritis Rheum. 2004;50(12):3897-903. DOI: 10.1002/art.20657.
  • Chang A, Hayes K, Dunlop D, Song J, Hurwitz D, Cahue S, et al. Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression. Arthritis Rheum. 2005;52(11):3515-9. DOI: 10.1002/art.21406.
  • Davis RB, Öunpuu S, Tyburski D, Gage JR. A gait analysis data collection and reduction technique. Hum Mov Sci. 1991;10(5):575-87. DOI: 10.1016/0167-9457(91)90046-Z.
  • Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005;365(9463):965-73. DOI: 10.1016/S0140- 6736(05)71086-2.
  • Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: Arthritis data from the third national health and nutrition examination survey 1991-1994. J Rheumatol. 2006;33(11):2271-9.
  • Doherty M. Risk factors for progression of knee osteoarthritis. Lancet. 2001;358(9284):775-6. DOI: 10.1016/S0140-6736(01)06006-8.
  • Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, et al. Osteoarthritis: New insights. part I: The disease and its risk factors. Ann Intern Med. 2000;133(8):635-46. DOI: 10.7326/0003-4819-133- 8-200010170-00016.
  • Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly: The Framinghan Osteoarthritis Study. Arthritis Rheum. 1987;30(8):914-8. DOI: 10.1002/ art.1780300811.
  • Felson DT, Newitt MC, Zhang Y, Aliabadi P, Baumer B, Gale D, et al. High prevalence of lateral knee osteoarthritis in beijing Chinese compared with Framingham Caucasian subjects. Arthritis Rheum. 2002;46(5):1217-22. DOI: 10.1002/art.10293.
  • Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman B, Aliabadi P, et al. Risk factors for incident radiographic knee osteoarthritis in the elderly. The Framingham study. Arthritis Rheum. 1997;40(4):728-33. DOI: 10.1002/art.1780400420.
  • Fernández-López JC, Laffon A, Blanco FJ, Carmona L. Prevalence, risk factors, and impact of knee pain suggesting osteoarthritis in Spain. Clin Exp Rheumatol. 2008;26(2):324-32.
  • Gök H, Ergin S, Yavuzer G. Kinetic and kinematic characteristics of gait in patients with medial knee arthrosis. Acta Orthop Scand. 2002;73(6):647-52. DOI: 10.3109/17453670209178029.
  • Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three dimensional motions: Application to the knee. J Biomech Eng. 1983;105(2):136-44. DOI: 10.1115/1.3138397.
  • Grotle M, Hagen KB, Natvig B, Dahl FA, Kvien TK. Obesity and osteoarthritis in knee, hip and/or hand: An epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet Disord. 2008;9:132. DOI: 10.1186/1471-2474-9-132.
  • Hair JF, Anderson RE, Tatham RL, Black WC. Multivariate data analysis. 5ª ed. New Jersey: Prentice-Hall, Inc.; 1998.
  • Henriksen MH, Aaboe J, Simonsen EB, Alkjaer T, Bliddal H. Experimentally reduced hip abductor function during walking: Implications for knee joint loads. J Biomech. 2009;42(9):1236-40. DOI: 10.1016/j.jbiomech.2009.03.021.
  • Hunt MA, Birmingham TB, Bryant D, Jones I, Giffin JR, Jenkyn TR, et al. Lateral trunk lean explains variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis. Osteoarthritis Cartilage. 2008;16(5):591-9. DOI: 10.1016/j.joca.2007.10.017.
  • Hunt MA, Birmingham TB, Giffin JR, Jenkyn TR. Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis. J Biomech. 2006;39(12):2213-20. DOI: 10.1016/j.jbiomech.2005.07.002.
  • Hurwitz DE, Ryals AB, Case JP, Block JA, Andriacchi TP. The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res. 2002;20(1):101-7. DOI: 10.1016/S0736-0266(01)00081-X.
  • Hurwitz DE, Summer DR, Andriacchi TP, Sugar DA. Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech. 1998;31(5):423-30. DOI: 10.1016/S0021-9290(98)00028-1
  • Jordan JM, Helkick CG, Renner JB, Luta G, Woodard J, Dragomir AD, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthirits in African-Americans and Caucasians: The Johnston County Osteoarthritis Project. J Rheumatol. 2007;34(1):172-80.
  • Kadaba MP, Ramakrishnan HK, Wootten ME. Measurements of lower extremity kinematics during level walking. J Orthop Res. 1990;8(3):383- 92. DOI: 10.1002/jor.1100080310.
  • Kakihana W, Akai M, Nakazawa K, Takashima T, Naito K, Torii S. Effects of laterally wedged insoles on knee and subtalar joint moments. Arch Phys Med Rehabil. 2005;86(7):1465-71. DOI: 10.1016/j.apmr.2004.09.033.
  • Kim WY, Richards J, Jones RK, Hegab A. A new biomechanical model for the functional assessment of knee ostearthritis. Knee. 2004;11(3):225- 31. DOI: 10.1016/S0968-0160(03)00068-1.
  • Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Knee biomechanis of moderate OA patients measured during gait at a self-selected and fast walking speed. J Biomech. 2007;40(8):1754-61. DOI: 10.1016/j.jbiomech.2006.08.010.
  • Lewek MD, Rudolph KS, Snyder-Mackler L. Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis. Osteoarthritis Cartilage. 2004;12(9):745-51. DOI: 10.1016/j. joca.2004.05.005.
  • Lynn SK, Costigan PA. Effect of foot rotation on knee kinetics and hamstring activation in older adults with and without signs of knee osteoarthritis. Clin Biomech. 2008;23(6):779-86. DOI: 10.1016/j.clinbiomech.2008.01.012.
  • Manninen P, Riihimaki H, Heliovaara M, Makela P. Overweight, gender and knee ostearthritis. Int J Obes Relat Metab Disord. 1996;20(6):595-7.
  • Martínez González MA, De Irala Estévez J, López Azpiacu I. Introducción a los modelos multivariables. En: Martínez González MA, De Irala Estévez J, Faulin Fajardo FJ, editores. Bioestadística amigable. Madrid: Díaz de Santos; 2001. p. 465-94.
  • Mündermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis. Arthritis Rheum. 2005;52(9):2835-44. DOI: 10.1002/art.21262.
  • Mündermann A, Dyrby CO, Hurwitz DE, Sharma L, Andriacchi TP. Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity. Arthritis Rheum. 2004;50(4):1172-8. DOI: 10.1002/art.20132.
  • Noyes FR, Schipplein OD, Andriacchi TP, Saddemi SR, Weise M. The anterior cruciate ligament-deficient knee with varus alignment. Am J Sports Med. 1992;20(6):707-16. DOI: 10.1177/036354659202000612.
  • Oliveira SA, Felson DT, Reed JI, Cirillo PA, Walker AM. Incidence of symptomatic hand, hip and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum. 1995;38(8):1134-41. DOI: 10.1002/art.1780380817.
  • Schache AG, Baker R. On the expression of joint moments during gait. Gait Posture 2007;25(3):440-52. DOI: 10.1016/j.gaitpost.2006.05.018.
  • Schipplein OD, Andriacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res. 1991;9(1):113-9. DOI: 10.1002/jor.1100090114.
  • Sharma L, Hurwitz DE, Thonar EJMA, Sum JA, Lenz ME, Dunlop DD, et al. Knee adduction moment, serum hyaluronan level, and disease severty in medial tibiofemoral osteoarthritis. Arthritis Rheum. 1998;41(7):1233-40. DOI: 10.1002/1529-0131(199807)41:73.0.CO;2-L.
  • Shelburne KB, Torry MR, Pandy MG. Contributions of muscle, ligaments, and the ground-reaction force to tibiofemoral joint loading during normal gait. J Orthop Res. 2006;24(10):1983-90. DOI: 10.1002/ jor.20255.
  • Shimada S, Kobayashi S, Wada M, Uchida K, Sasaki S, Kawahara H, et al. Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee ostearthritis. Arch Phys Med Rehabil. 2006;87(11):1436-41. DOI: 10.1016/j.apmr.2006.08.018.
  • Sociedad Española de Reumatología. Estudio EPISER: Prevalencia de las enfermedades reumáticas en la población española. España: Merck, Sharp & Dohme; 2001.
  • Specogna AV, Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, et al. Radiographic measures of knee alignment in patients with varus gonarthrosis. Effect of weightbearing status and associations with dynamics joint load. Am J Sports Med. 2007;35(1):65-70. DOI: 10.1177/0363546506293024.
  • Taylor WR, Heller MO, Bergmann G, Duda GN. Tibio-femoral loading during human gait and stair climbing. J Orthop Res. 2004;22(3):635-2. DOI: 10.1016/j.orthres.2003.09.003
  • Thorp LE, Wimmer MA, Block JA, Moisio KC, Shott S, Goker B, et al. Bone mineral density in the proximal tibia varies as a function of static alignment and knee adduction angular momentum in individuals with medial knee osteoarthritis. Bone. 2006;39(5):1116-22. DOI: 10.1016/j. bone.2006.05.001.
  • Wada M, Imura S, Nagatani K, Baba H, Shimada S, Sasaki S. Relationship between gait and clinical results after high tibial osteotomy. Clin Orthop Relat Res. 1998;354:180-8. DOI: 10.1097/00003086-199809000- 00022.
  • Wada M, Maezawa Y, Baba H, Shimada S, Sasaki S, Nose Y. Relationship among bone mineral densities, static alignment and dynamic load in patients with medial compartment knee osteoarthritis. Rheumatology (Oxford). 2001;40(5):449-505. DOI: 10.1093/rheumatology/40.5.499.
  • Weidenhielm L, Svenson OK, Brostom LA, Mattson E. Adduction moment of the knee compared to radiological and clinical parameters in moderate medial osteoarthrosis of the knee. Ann Chir Gynaecol. 1994;83(3):236-42.
  • Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Rheum Dis Clin North Am. 2008;34(3):515-29. DOI: 10.1016/j.rdc.2008.05.007.
  • Zhang Y, Xu L, Nevitt MC, Aliabadi P, Yu W, Qin M, et al. Comparison of the prevalence of knee osteoarthirits between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study. Arthritis Rheum 2001;44(9):2065-71. DOI: 10.1002/1529-0131(200109)44:93.0.CO;2-Z.