A knee flexion contracture is associated with a contracture and worse function of the contralateral knee: data from the Osteoarthritis Initiative

Publication date: Available online 7 January 2020

Source: Archives of Physical Medicine and Rehabilitation

Author(s): T Mark Campbell, Guy Trudel

Abstract

Objective

Patients at-risk of, or those with knee osteoarthritis (OA) may present with a knee flexion contracture (FC). A knee FC can cause pain and can decrease function. By altering lower extremity biomechanics, the impact of a knee FC goes beyond the affected joint. Compensatory movements during gait can chronically affect other joints in both lower limbs. Few studies describe the impact of a knee FC on, or direct assessment toward, the contralateral knee. We investigated the associations between knee FC with range of extension, function, pain, and stiffness of the contralateral knee.

Design

Cross-sectional, using the Osteoarthritis Initiative database.

Setting/Participants

Outpatient cohort study, recruiting from four United States academic health care centers. Two groups were included: those at-risk of (n=3284 knees), and those with (n=1390 knees) radiographic OA.

Main Outcomes Measures

Maximum contralateral knee extension, and Western Ontario and McMaster Osteoarthritis Index (WOMAC) scores. Statistical analysis included a mixed linear model evaluating for independent associations between the index knee FC and contralateral knee outcome measures.

Results

A knee FC was associated with a contralateral knee FC (p<0.001) with contralateral FC severity dependent on severity of the index knee FC (p<0.001). Participants at-risk for OA with moderate FC showed worse function in the contralateral knee compared with mild FC (WOMAC functional subscale: 7.6±10.1 versus 5.5±8.8; p=0.036). Mixed linear analysis confirmed an independent association between knee FC severity and contralateral WOMAC function.

Conclusions

Having a FC in one knee was associated with FC in the contralateral knee for both at-risk and OA participants. For those at-risk of OA, the severity of knee FC was an independent predictor for loss of contralateral knee function. Rehabilitation of patients with, or at-risk of OA should consider the restoration of extension and function for both knees.

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