Coordination of joint movement during gait in knee osteoarthritis: Insights from uncontrolled manifold analysis

This study investigated the covariate structure of each segmental angle that stabilize the center of mass (COM) in the mediolateral and vertical directions in response to knee joint movement in individuals with knee osteoarthritis (KOA) using uncontrolled manifold (UCM) analysis. Twenty individuals with KOA and 13 healthy controls participated in this cross-sectional study. Kinematic and kinetic data were collected during level walking. UCM analysis was used to determine the covariance structure of segment angles stabilizing the COM in the mediolateral and vertical directions. The results indicated reduced knee flexion movement during the stance phase in the KOA group. In the mediolateral direction, the KOA group exhibited increased kinematic synergy stabilizing the COM. However, in the vertical direction, decreased kinematic synergy was observed. KOA group demonstrated greater trial-to-trial variances in segmental angles constituting the knee joint, suggesting enhanced covariance structure attempting to stabilize the COM in the mediolateral direction but increasing variability that destabilizes the COM in the vertical direction. Furthermore, decreased knee flexion movement during loading response may lead to reduced vertical kinematic synergy. In conclusion, these findings underscore the need to address improving knee flexion movement during the loading response to prevent osteoarthritis progression in patients with KOA. It provides insights into interventions focusing on improving knee flexion and enhancing kinematic synergy in the vertical direction, potentially benefiting patients with KOA.