The association of external knee adduction moment with biomechanical variables in osteoarthritis: A systematic review

Context: Osteoarthritis (OA) is a musculoskeletal disorder primarily affecting the older population and resulting in chronic pain and disability. Biomechanical variables, associated with OA severity such as external knee adduction moment (KAM) and joint malalignment, may affect the disease process by altering the bone-on-bone forces during gait. Objective: To investigate the association between biomechanical variables and KAM in knee OA. Method: A systematic search for published studies' titles and abstracts was performed on Ovid Medline (R), Cumulative index to Nursing and Allied Health, PREMEDLINE, EBM reviews and SPORTDiscus. Fourteen studies met the inclusion criteria and were considered for the review. Results: The magnitude and time course of KAM during gait appeared to be consistent across laboratories and computational methods. Only two of the included studies that compared patients with OA to a control group reported a higher peak KAM for the OA group. Knee adduction moment increased with CA severity and was directly proportional to varus malalignment. Classifying the patients on the basis of disease severity decreased the group variability, permitting the differences to be more detectable. Conclusions: Biomechanical variables such as varus rnilalignment are associated with KAM and therefore may affect the disease process. These variables should be taken into considerations when developing therapeutic interventions for individuals suffering from knee OA. Crown Copyright (C) 2008 Published by Elsevier B.V. All rights reserved.