Cumulative knee adductor load distinguishes between healthy and osteoarthritic knees--a proof of principle study

Cumulative knee adductor load reflects repetitive exposures to medial knee loading that are encountered during daily activity. The purpose of this proof of principle study was to investigate whether cumulative knee adductor load distinguished between adults with and without knee osteoarthritis (OA). Thirty-one adults with radiographic knee OA (53.2±6.1 years old) and 30 healthy adults (33.5±8.0 years old) participated. A non-normalized knee adduction moment waveform was calculated from gait data collected using a motion analysis system with synchronized force plate. The peak and impulse from knee adduction moment was calculated. Cumulative knee adductor load was the product of the knee adduction moment impulse during stance and the mean number of steps taken per day, measured with a uni-dimensional accelerometer. One thousand bootstrap t-tests determined whether cumulative knee adductor load was at least as good as the peak knee adduction moment in discriminating between the healthy and OA groups. Cumulative knee adductor load was nearly two times larger in the knee OA compared to the healthy group (p=0.001). Cumulative knee adductor load was better than the peak knee adduction moment at discriminating between groups (p=0.04). This work provides evidence of validity for cumulative knee adductor load. In the calculation of cumulative loads, non-normalization of the adduction moment impulse to magnitude or time emphasized the importance of the total loads borne through the medial knee compartment during each step.