SpringerLink
Log in

Meta-analysis on the association between knee extensor strength and structural changes of knee osteoarthritis

  • Review Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

This study aimed to perform a meta-analysis to evaluate whether knee extensor (KE) strength weakness was associated with increased structural worsening in knee osteoarthritis (KOA) including joint space narrowing (JSN) and cartilage loss. PubMed, Embase, Scopus, ScienceDirect, Web of Science, and Cochrane library were searched from their inception to May 2020, to identify eligible studies. Odds ratios (ORs) accompanied by 95% confidence intervals (CIs) were calculated for the relationship between KE strength and outcomes. Totally eleven longitudinal studies were included. The pooled crude OR indicated no significant association between KE strength weakness and KOA progression of JSN (OR: 1.13, 95% CI: 0.90, 1.42), and this result duplicated after confounders were adjusted (OR: 1.10, 95% CI: 0.87, 1.39). Subgroup analysis showed the association remained non-significant in sex-specific outcomes and subsets of neutral and malaligned knees, but there was a trend toward increased risk of JSN progression in female knees with low strength (OR: 1.24, 95% CI: 0.87, 1.76, I2 = 82%). The pooled crude OR showed that KE strength weakness was associated with increased risk of cartilage loss (OR:1.43, 95% CI: 1.05, 1.95). After adjustment, we found a non-significant trend that low KE strength could increase the risk of cartilage loss (OR: 1.25, 95% CI: 0.95, 1.64), and this trend was separately observed in tibiofemoral or patellofemoral compartments. This meta-analysis suggested that KE strength weakness was not significantly associated with an increased risk of radiographic structural KOA progression in patients with KOA or known risk factors for KOA. However, there was a trend that women with weaker KE strength displayed a higher risk of JSN worsening and that KE strength weakness had an association with an increased risk of cartilage damage.

Key points

• Knee extensor strength weakness is not significantly associated with an increased risk of radiographic structural KOA progression in patients with or at risk of knee osteoarthritis.

• There is a non-significant trend toward an increased risk of JSN progression in female knees with low knee extensor strength.

• There is a trend that low KE strength can increase the risk of cartilage loss no matter in tibiofemoral or patellofemoral compartments, but it’s not significant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

All data are available in the manuscript.

References

  1. Hunter DJ, Schofield D, Callander E (2014) The individual and socioeconomic impact of osteoarthritis. Nature reviews Rheumatology. 10(7):437–441

    Article  Google Scholar 

  2. Zhang Y, Xu L, Nevitt MC, Aliabadi P, Yu W, Qin M, Lui LY, Felson DT (2001) Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Bei**g and whites in the United States: The Bei**g Osteoarthritis Study. Arthritis and rheumatism. 44(9):2065–2071

    Article  CAS  Google Scholar 

  3. Yoshimura N, Muraki S, Oka H, Mabuchi A, En-Yo Y, Yoshida M, Saika A, Yoshida H, Suzuki T, Yamamoto S, Ishibashi H, Kawaguchi H, Nakamura K, Akune T (2009) Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study. Journal of bone and mineral metabolism. 27(5):620–628

    Article  Google Scholar 

  4. Anderson JJ, Felson DT (1988) Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. American journal of epidemiology. 128(1):179–189

    Article  CAS  Google Scholar 

  5. Davis MA, Ettinger WH, Neuhaus JM, Hauck WW (1988) Sex differences in osteoarthritis of the knee. The role of obesity. American journal of epidemiology. 127(5):1019–1030

    Article  CAS  Google Scholar 

  6. Mazzuca SA, Brandt KD, Dieppe PA, Doherty M, Katz BP, Lane KA (2001) Effect of alignment of the medial tibial plateau and x-ray beam on apparent progression of osteoarthritis in the standing anteroposterior knee radiograph. Arthritis and rheumatism. 44(8):1786–1794

    Article  CAS  Google Scholar 

  7. Peach CA, Carr AJ, Loughlin J (2005) Recent advances in the genetic investigation of osteoarthritis. Trends in molecular medicine. 11(4):186–191

    Article  CAS  Google Scholar 

  8. Winby CR, Lloyd DG, Besier TF, Kirk TB (2009) Muscle and external load contribution to knee joint contact loads during normal gait. Journal of biomechanics. 42(14):2294–2300

    Article  CAS  Google Scholar 

  9. Brandt KD, Heilman DK, Slemenda C, Katz BP, Mazzuca SA, Braunstein EM, Byrd D (1999) Quadriceps strength in women with radiographically progressive osteoarthritis of the knee and those with stable radiographic changes. The Journal of rheumatology. 26(11):2431–2437

    CAS  PubMed  Google Scholar 

  10. Sharma L, Dunlop DD, Cahue S, Song J, Hayes KW (2003) Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Ann Intern Med. 138(8):613–619

    Article  Google Scholar 

  11. Amin S, Baker K, Niu J, Clancy M, Goggins J, Guermazi A, Grigoryan M, Hunter DJ, Felson DT (2009) Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis and rheumatism. 60(1):189–198

    Article  Google Scholar 

  12. Segal NA, Glass NA, Torner J, Yang M, Felson DT, Sharma L, Nevitt M, Lewis CE (2010) Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis and cartilage. 18(6):769–775

    Article  CAS  Google Scholar 

  13. Hunter DJ, Zhang YQ, Tu X, Lavalley M, Niu JB, Amin S et al (2006) Change in joint space width: hyaline articular cartilage loss or alteration in meniscus? Arthritis and rheumatism. 54(8):2488–2495

    Article  CAS  Google Scholar 

  14. Culvenor AG, Ruhdorfer A, Juhl C, Eckstein F, Øiestad BE (2017) Knee extensor strength and risk of structural, symptomatic, and functional decline in knee osteoarthritis: a systematic review and meta-analysis. Arthritis care & research. 69(5):649–658

    Article  Google Scholar 

  15. Bastick AN, Belo JN, Runhaar J, Bierma-Zeinstra SM (2015) What are the prognostic factors for radiographic progression of knee osteoarthritis? A meta-analysis. Clinical orthopaedics and related research. 473(9):2969–2989

    Article  Google Scholar 

  16. Chapple CM, Nicholson H, Baxter GD, Abbott JH (2011) Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies. Arthritis care & research. 63(8):1115–1125

    Article  Google Scholar 

  17. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 62(10):1006–1012

    Article  Google Scholar 

  18. Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M et al (2012) The newcastle-ottawa scale(NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric. 18:727–734

    Google Scholar 

  19. Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions, version 5.1.0. Wiley, Chichester

    Google Scholar 

  20. Chin C, Sayre EC, Guermazi A, Nicolaou S, Esdaile JM, Kopec J, Thorne A, Singer J, Wong H, Cibere J (2019) Quadriceps weakness and risk of knee cartilage loss seen on magnetic resonance imaging in a population-based cohort with knee pain. The Journal of rheumatology. 46(2):198–203

    Article  Google Scholar 

  21. Culvenor AG (2019) Segal NA. Sex-specific influence of quadriceps weakness on worsening patellofemoral and tibiofemoral cartilage damage: a prospective cohort study. 71(10):1360–1365

    Google Scholar 

  22. Dell'isola A, Wirth W, Steultjens M, Eckstein F, Culvenor AG (2018) Knee extensor muscle weakness and radiographic knee osteoarthritis progression. Acta orthopaedica. 89(4):406–411

    Article  Google Scholar 

  23. Goldman LH, Tang K, Facchetti L, Heilmeier U, Joseph GB, Nevitt MC, McCulloch CE, Souza RB, Link TM (2016) Role of thigh muscle cross-sectional area and strength in progression of knee cartilage degeneration over 48 months - data from the Osteoarthritis Initiative. Osteoarthritis and cartilage. 24(12):2082–2091

    Article  CAS  Google Scholar 

  24. Hall M, Wrigley TV, Metcalf BR, Cicuttini FM, Wang Y, Hinman RS et al (2015) Do moments and strength predict cartilage changes after partial meniscectomy? Medicine and science in sports and exercise. 47(8):1549–1556

    Article  Google Scholar 

  25. Miyazaki T, Uchida K, Sato M, Watanabe S, Yoshida A, Wada M, Shimada S, Kuiper JH, Baba H (2012) Knee laxity after staircase exercise predicts radiographic disease progression in medial compartment knee osteoarthritis. Arthritis and rheumatism. 64(12):3908–3916

    Article  Google Scholar 

  26. Takagi S, Omori G, Koga H, Endo K, Koga Y, Nawata A, Endo N (2018) Quadriceps muscle weakness is related to increased risk of radiographic knee OA but not its progression in both women and men: the Matsudai Knee Osteoarthritis Survey. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA. 26(9):2607–2614

    Article  Google Scholar 

  27. Thorstensson CA, Petersson IF, Jacobsson LT, Boegård TL, Roos EM (2004) Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later. Annals of the rheumatic diseases. 63(4):402–407

    Article  CAS  Google Scholar 

  28. Hurley MV (1999) The role of muscle weakness in the pathogenesis of osteoarthritis. Rheumatic diseases clinics of North America. 25(2):283–298 vi

    Article  CAS  Google Scholar 

  29. Jefferson RJ, Collins JJ, Whittle MW, Radin EL, O'Connor JJ (1990) The role of the quadriceps in controlling impulsive forces around heel strike. Proceedings of the Institution of Mechanical Engineers Part H, Journal of engineering in medicine. 204(1):21–28

    Article  CAS  Google Scholar 

  30. Segal NA, Glass NA (2011) Is quadriceps muscle weakness a risk factor for incident or progressive knee osteoarthritis? The Physician and sportsmedicine. 39(4):44–50

    Article  Google Scholar 

  31. Baker KR, Xu L, Zhang Y, Nevitt M, Niu J, Aliabadi P, Yu W, Felson D (2004) Quadriceps weakness and its relationship to tibiofemoral and patellofemoral knee osteoarthritis in Chinese: the Bei**g osteoarthritis study. Arthritis and rheumatism. 50(6):1815–1821

    Article  Google Scholar 

  32. Ploutz-Snyder LL, Manini T, Ploutz-Snyder RJ, Wolf DA (2002) Functionally relevant thresholds of quadriceps femoris strength. The journals of gerontology Series A, Biological sciences and medical sciences. 57(4):B144–B152

    Article  Google Scholar 

  33. Buchner D, de Lateur BJ (1991) The importance of skeletal muscle strength to physical function in older adults. Ann Behav Med. 13:91–98

    Google Scholar 

  34. Schmitz RJ, Ficklin TK, Shimokochi Y, Nguyen AD, Beynnon BD, Perrin DH, Shultz SJ (2008) Varus/valgus and internal/external torsion knee joint stiffness differs between sexes. Am J Sports Med. 36(7):1380–1388

    Article  Google Scholar 

  35. Felson DT, Kim YJ (2007) The futility of current approaches to chondroprotection. Arthritis and rheumatism. 56(5):1378–1383

    Article  Google Scholar 

  36. Culvenor AG, Wirth W, Ruhdorfer A, Eckstein F (2016) Thigh muscle strength predicts knee replacement risk independent of radiographic disease and pain in women: data from the osteoarthritis initiative. Arthritis Rheumatol (Hoboken, NJ) 68(5):1145–1155

    Google Scholar 

  37. Øiestad BE, Juhl CB, Eitzen I, Thorlund JB (2015) Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthritis and cartilage. 23(2):171–177

    Article  Google Scholar 

  38. Sakai N, Luo ZP, Rand JA, An KN (2000) The influence of weakness in the vastus medialis oblique muscle on the patellofemoral joint: an in vitro biomechanical study. Clin Biomech (Bristol, Avon) 15(5):335–339

    Article  CAS  Google Scholar 

  39. Andriacchi TP, Mündermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S (2004) A framework for the in vivo pathomechanics of osteoarthritis at the knee. Annals of biomedical engineering. 32(3):447–457

    Article  Google Scholar 

  40. Ruhdorfer A, Wirth W, Hitzl W, Nevitt M, Eckstein F (2014) Association of thigh muscle strength with knee symptoms and radiographic disease stage of osteoarthritis: data from the Osteoarthritis Initiative. Arthritis care & research. 66(9):1344–1353

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tian** Third Central Hospital, **-tang Road No.83, Tian**, 300170, China

    **aobin Hou & Guoyue Yang

Authors
  1. **aobin Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guoyue Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to **aobin Hou.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOC 62 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hou, X., Yang, G. Meta-analysis on the association between knee extensor strength and structural changes of knee osteoarthritis. Clin Rheumatol 40, 3511–3521 (2021). https://doi.org/10.1007/s10067-021-05634-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-021-05634-6

Keywords

Search

Navigation