Knee adduction moment and medial contact force--facts about their correlation during gait

Abstract

The external knee adduction moment is considered a surrogate measure for the medial tibiofemoral contact force and is commonly used to quantify the load reducing effect of orthopedic interventions. However, only limited and controversial data exist about the correlation between adduction moment and medial force. The objective of this study was to examine whether the adduction moment is indeed a strong predictor for the medial force by determining their correlation during gait. Instrumented knee implants with telemetric data transmission were used to measure tibiofemoral contact forces in nine subjects. Gait analyses were performed simultaneously to the joint load measurements. Skeletal kinematics, as well as the ground reaction forces and inertial parameters, were used as inputs in an inverse dynamics approach to calculate the external knee adduction moment. Linear regression analysis was used to analyze the correlation between adduction moment and medial force for the whole stance phase and separately for the early and late stance phase. Whereas only moderate correlations between adduction moment and medial force were observed throughout the whole stance phase (R(2) = 0.56) and during the late stance phase (R(2) = 0.51), a high correlation was observed at the early stance phase (R(2) = 0.76). Furthermore, the adduction moment was highly correlated to the medial force ratio throughout the whole stance phase (R(2) = 0.75). These results suggest that the adduction moment is a surrogate measure, well-suited to predicting the medial force ratio throughout the whole stance phase or medial force during the early stance phase. However, particularly during the late stance phase, moderate correlations and high inter-individual variations revealed that the predictive value of the adduction moment is limited. Further analyses are necessary to examine whether a combination of other kinematic, kinetic or neuromuscular factors may lead to a more reliable prediction of the force magnitude.

Figure 1. Medial contact forces F_med (A) and external adduction moments EAM (B) during the stance phase of gait.

Forces are given in % of bodyweight (BW) and moments in %BW times height (Ht). Average curves from 6 repeated trials per subject were calculated using a dynamic time warping procedure .

Figure 2. Correlation between external adduction moments EAM and medial contact forces F_med during gait.

Correlation between EAM and F_med during the whole (A), early (C) and late (D) stance phase of gait and correlation between EAM and medial force ratio (B) during the whole stance phase (6 trials per subject).

Figure 3. Correlation between peak medial forces F_med and external adduction moments EAM.

Correlation between peak values of F_med (A) or medial force ratios (B) and EAM at early stance (peak 1) and late stance phase (peak 2). Average peak values of nine subjects.