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Joost Dekker PhDDepartment of Psychiatry & Department of Rehabilitation MedicineVU University Medical Center, Amsterdam, Netherlands
Knikkende knieënOver instabiliteit en loopvaardigheid bij
artrose van de knie
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Osteoarthritis
• Prevalence symptomatic OA in among adults aged ≥45 years– Knee 16.7% – Hip 9.2%
• Top 10 of most disabling diseases in European region
• Most important cause of pain and disability in the
elderly
Jordan et al, 2007
WHO, 2008
Conaghan et al, 2008
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• Impairments of cartilage and bone– Findings on X-rays, MRI
• Physical impairments– Muscle weakness, instability
• Sensory impairments– Pain, stiffness, instability
• Activity limitations– Walking, rising
• Problems in participation– Work
Osteoarthritis – multiple levels
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• Impairments of cartilage and bone– Findings on X-rays, MRI
• Physical impairments– Muscle weakness, instability
• Sensory impairments– Pain, stiffness, instability
• Activity limitations– Walking, rising
• Problems in participation– Work
Osteoarthritis – multiple levels
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Instability
• Sudden loss of postural support across the knee at a time a weight bearing
• Self report – Sensation of buckling, shifting, or giving way of the knee– Sensory impairment
• Observed measure– To be developed– Physical impairment
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Felson et al, 2007
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Instability
• In knee OA– 60 – 80 %
• Instability is associated with activity limitations– Walking speed, self reported walking limitations
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Fitzgerald et al, 2004
Schmitt et al, 2008
van der Esch et al, 2012
Knoop et al, 2012
Nguyen et al, 2014
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Instability
• In knee OA– 60 – 80 %
• Instability is associated with activity limitations
• … and with falls
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Fitzgerald et al, 2004
Schmitt et al, 2008
van der Esch et al, 2012
Knoop et al, 2012
Nguyen et al, 2014
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Instability
• Reduced muscle strength is associated with instability• Quadriceps and hamstring muscles are stabilizers of the knee
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Knoop et al, 2012
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van der Esch et al, 2006
Proprioception - perception of position and movement
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muscle strength Nm/kg
2,52,01,51,0,50,0
wal
k-tim
e (1
00 m
) se
c.
220
200
180
160
140
120
100
80
60
40
proprioception
poor
accurate
muscle strength Nm/kg
2,52,01,51,0,50,0
GU
G-ti
me
sec.
50
40
30
20
10
0
proprioception
poor
accurate
muscle strength Nm/kg
2,52,01,51,0,50,0
WO
MAC
-PF
scor
e
60
50
40
30
20
10
0
proprioception
poor
accurate
Muscle strength, proprioception and activity limitations
van der Esch et al, 2007
Replication Holla et al, 201213
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Pain
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Felson et al, 2007
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Arthrogenic muscle inhibition
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Stokes and Young, 1984
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Tactile stimulation
• Lack (-/-) tactile stimulation – Instability ?
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Arthrogenic muscle inhibition
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Rice and McNair, 2010
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Tactile stimulation
• Lack tactile stimulation (-/-) – Instability ?
• Additional tactile stimulation (+/+) – Soft brace
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Additional tactile stimulation
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Pegoretti et al, 2015
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Instability in knee OA
• Highly prevalent– 60 – 80 %
• Activity limitations (walking), falls
• Muscle strength
• Proprioception• Pain• Tactile stimulation
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Instability in knee OA
• Highly prevalent– 60 – 80 %
• Activity limitations (walking), falls
• Muscle strength
• Proprioception• Pain• Tactile stimulation
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Exercise therapy
Soft brace
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