Neuromuscular factors related to varus thrust during walking in knee osteoarthritis

BACKGROUND: Up to 37% of people with knee osteoarthritis (OA) present with varus thrust, an abrupt and dynamic worsening of varus alignment during the load-bearing stages of gait. Varus thrust is associated with up to 4-fold increased odds of medial knee OA progression as well as worsening clinical outcomes. While the implications of varus thrust have been well studied, the neuromuscular factors related to varus thrust are still not well understood and many studies report contradictory findings. Additionally, many potential factors remain unstudied. This warrants further efforts to determine associations between neuromuscular factors and varus thrust. The purpose of this study is to investigate knee muscle strength and muscle activation during walking in relation to biomechanical measures of varus thrust. METHODS: Analyses of existing data from participants with and without knee OA recruited at three institutions were used for this study. All participants underwent gait analyses at their self-selected pace while kinematics, kinetics, and surface EMG data were collected. Quadriceps and hamstrings strength was measured using isokinetic dynamometry. Gait data were used to calculate adduction excursion and peak knee adduction velocity as measures of varus thrust. A custom MATLAB code was used to calculate the rate of force development of the quadriceps, and a muscular co-contraction equation was used to calculate co-contraction values for four antagonist muscle pairs (VL-LH, VM-MH, VL-LG, and VM-MG) from surface EMG data during walking. Correlational analyses were performed to assess associations of strength, rate of force development, and muscle co-contraction variables with measures of varus thrust. RESULTS: A total of 183 participants were enrolled, however, a varying number of participants were used for different analyses based on available data. Peak isokinetic quadriceps strength at 60 degrees/second and peak hamstrings strength at both 60 and 120 degrees/second were negatively correlated with knee adduction velocity in people with knee OA. This association was not observed for people without knee OA. VLLH and VMMH co-contraction indices during preactivation were positively correlated with knee adduction excursion. VLLG co-contraction during midstance was positively correlated with peak knee adduction velocity. Association between rate of force development and varus thrust variables was not significant. CONCLUSIONS: Lower isokinetic thigh muscle strength and greater preactivation during walking are related to greater magnitude of varus thrust measured using motion capture. These results advance our understanding of neuromuscular factors related to varus thrust and could inform future interventions to reduce thrust and prevent further progression of OA.2020-06-14T00:00:00