External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis

A. H. Chang*, K. C. Moisio, J. S. Chmiel, F. Eckstein, A. Guermazi, P. V. Prasad, Y. Zhang, O. Almagor, L. Belisle, K. Hayes, L. Sharma

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

187 Citations (Scopus)


Objective: Test the hypothesis that greater baseline peak external knee adduction moment (KAM), KAM impulse, and peak external knee flexion moment (KFM) during the stance phase of gait are associated with baseline-to-2-year medial tibiofemoral cartilage damage and bone marrow lesion progression, and cartilage thickness loss. Methods: Participants all had knee OA in at least one knee. Baseline peak KAM, KAM impulse, and peak KFM (normalized to body weight and height) were captured and computed using a motion analysis system and six force plates. Participants underwent MRI of both knees at baseline and 2 years later. To assess the association between baseline moments and baseline-to-2-year semiquantitative cartilage damage and bone marrow lesion progression and quantitative cartilage thickness loss, we used logistic and linear regressions with generalized estimating equations (GEE), adjusting for gait speed, age, gender, disease severity, knee pain severity, and medication use. Results: The sample consisted of 391 knees (204 persons): mean age 64.2 years (SD 10.0); BMI 28.4 kg/m2 (5.7); 156 (76.5%) women. Greater baseline peak KAM and KAM impulse were each associated with worsening of medial bone marrow lesions, but not cartilage damage. Higher baseline KAM impulse was associated with 2-year medial cartilage thickness loss assessed both as % loss and as a threshold of loss, whereas peak KAM was related only to % loss. There was no relationship between baseline peak KFM and any medial disease progression outcome measures. Conclusion: Findings support targeting KAM parameters in an effort to delay medial OA disease progression.

Original languageEnglish
JournalOsteoarthritis and Cartilage
Issue number7
Pages (from-to)1099-1106
Number of pages8
Publication statusPublished - 1 Jul 2015
Externally publishedYes

Bibliographical note

Funding Information:
Support for this project comes from National Institutes of Health (NIH) P60 AR064464 (PI: Sharma), NIH R01 AR054806 (PI: Sharma), and NIH R01 AR048748 (PI: Sharma).

Publisher Copyright:
© 2015 Osteoarthritis Research Society International.


  • Biomechanics
  • Gait
  • Knee osteoarthritis


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