Higher knee flexion moment during walking is associated with a lower risk of knee pain developing among the elderly after 24 months

BACKGROUND: Knee pain is one of the main problems associated with knee osteoarthritis. The peak external knee adduction moment (KAM) in gait is commonly used to estimate medial knee loading, and elevated KAM has been related to a higher risk of developing knee pain in older adults. Although knee flexion moment (KFM) also contributes to medial knee loading, its role in the development of knee pain remains unclear. AIM: To investigate the association between knee moments and the incidence of knee pain in 24 months in asymptomatic older adults. DESIGN: Prospective cohort study. SETTING: University laboratory. POPULATION: Community-dwelling adults aged 60-80 years were recruited. We excluded participants with knee pain/known arthritis, knee injury, knee/hip joint replacement, cognitive impairment, or neurological conditions. METHODS: Three-dimensional gait analysis was conducted to compute the peak KFM and KAM. Telephone surveys were conducted 12 and 24 months after the baseline assessment. Self-reported knee pain and its intensity and frequency were captured. Logistic regression with generalized estimating equations was used to examine associations between knee moments and the risk of knee pain. RESULTS: Of the 162 eligible participants who completed the baseline assessment (age: 65.8±4.0 years, 61.1% females), 157 and 138 were also assessed for incident knee pain after 12 and 24 months, respectively. Compared with the lowest tertile, the highest tertile of KFM was significantly related to a lower incidence of frequent knee pain (RR=0.25, 95% CI: 0.08-0.85, P=0.027) in 24 months. In addition, a higher KFM was significantly associated with the lower intensity of incident knee pain after 24 months (β=-1.513; 95% CI: -2.879, -0.147; P=0.030). We also observed trends showing that a higher peak KAM was related to higher risks of developing any (RR=2.48, 95% CI: 0.99-6.20, P=0.053) and frequent (RR=3.82, 95% CI: 0.96-15.1, P=0.057) knee pain in 24 months. CONCLUSIONS: A higher sagittal knee moment is associated with a lower risk of knee pain developing in 24 months in older adults. CLINICAL REHABILITATION IMPACT: Interventions for promoting sagittal knee moment may be considered in preventative training programs for reducing knee pain among older adults.