Background:
Knee buckling is common in persons with advanced knee osteoarthritis and after orthopedic procedures. Its prevalence in the community is unknown.
Objective:
To examine the prevalence of knee buckling in the community, its associated risk factors, and its relation to functional limitation.
Design:
Cross-sectional, population-based study.
Setting:
The Framingham Osteoarthritis Study.
Participants:
2351 men and women age 36 to 94 years (median, 63.5 years).
Measurements:
Participants were asked whether they had experienced knee buckling or “giving way” and whether it led to falling. They were also asked about knee pain and limitations in function by using the Short Form-12 and Western Ontario and McMaster Universities Osteoarthritis Index, had isometric tests of quadriceps strength, and underwent weight-bearing radiography and magnetic resonance imaging of the knee. Radiographs were scored for osteoarthritis by using the Kellgren–Lawrence scale, and magnetic resonance images were read for anterior cruciate ligament tears. The relationship of buckling to functional limitation was examined by using logistic regression that adjusted for age, sex, body mass index, and knee pain severity.
Results:
Two hundred seventy-eight participants (11.8%) experienced at least 1 episode of knee buckling within the past 3 months; of these persons, 217 (78.1%) experienced more than 1 episode and 35 (12.6%) fell during an episode. Buckling was independently associated with the presence of knee pain and with quadriceps weakness. Over half of those with buckling had no osteoarthritis on radiography. Persons with knee buckling had worse physical function than those without buckling, even after adjustment for severity of knee pain and weakness. For example, 46.9% of participants with buckling and 21.7% of those without buckling reported limitations in their work (adjusted odds ratio, 2.0 [95% CI, 1.5 to 2.7]).
Limitation:
Causal inferences are limited because of the study's cross-sectional design.
Conclusion:
In adults, knee buckling is common and is associated with functional loss.
References
- 1.
Fitzgerald GK ,Piva SR ,Irrgang JJ . Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum. 2004;51:941-6. [PMID:15593258 ] CrossrefMedlineGoogle Scholar - 2.
Peat G ,McCarney R ,Croft P . Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60:91-7. [PMID:11156538 ] CrossrefMedlineGoogle Scholar - 3.
Hannan MT ,Felson DT ,Pincus T . Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27:1513-7. [PMID:10852280 ] MedlineGoogle Scholar - 4.
Brandt KD . Osteoarthritis.. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson L, et al, eds. Harrison's Online. 16th ed. New York: McGraw-Hill; 2005. Google Scholar - 5.
Kalunian KC ,Brion PH ,Wollaston SJ . Clinical manifestations of osteoarthritis.. In: Rose BD, eds. UpToDate Online, version 15.1. Waltham, MA: UpToDate; 2007. Google Scholar - 6.
Yercan HS ,Ait Si Selmi T ,Sugun TS ,Neyret P . Tibiofemoral instability in primary total knee replacement: A review Part 2: diagnosis, patient evaluation, and treatment. Knee. 2005;12:336-40. [PMID:16137888 ] CrossrefMedlineGoogle Scholar - 7.
Cummings JR ,Pedowitz RA . Knee instability: the orthopedic approach. Semin Musculoskelet Radiol. 2005;9:5-16. [PMID:15812708 ] CrossrefMedlineGoogle Scholar - 8. Houck J, Lerner A, Gushue D, Yack HJ. Self-reported giving-way episode during a stepping-down task: case report of a subject with an ACL-deficient knee. J Orthop Sports Phys Ther. 2003;33:273-82; discussion 283-6. [PMID: 12775001] Google Scholar
- 9.
Neyret P ,Robinson AH ,Le Coultre B ,Lapra C ,Chambat P . Patellar tendon length—the factor in patellar instability? Knee. 2002;9:3-6. [PMID:11830373 ] CrossrefMedlineGoogle Scholar - 10.
Arden NK ,Crozier S ,Smith H ,Anderson F ,Edwards C ,Raphael H ,et al . Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheum. 2006;55:610-5. [PMID:16874784 ] CrossrefMedlineGoogle Scholar - 11.
Felson DT ,Couropmitree NN ,Chaisson CE ,Hannan MT ,Zhang Y ,McAlindon TE ,et al . Evidence for a Mendelian gene in a segregation analysis of generalized radiographic osteoarthritis: the Framingham Study. Arthritis Rheum. 1998;41:1064-71. [PMID:9627016 ] CrossrefMedlineGoogle Scholar - 12.
Karlson EW ,Sanchez-Guerrero J ,Wright EA ,Lew RA ,Daltroy LH ,Katz JN ,et al . A connective tissue disease screening questionnaire for population studies. Ann Epidemiol. 1995;5:297-302. [PMID:8520712 ] CrossrefMedlineGoogle Scholar - 13.
Cummings SR ,Nevitt MC ,Kidd S . Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc. 1988;36:613-6. [PMID:3385114 ] CrossrefMedlineGoogle Scholar - 14.
Bellamy N ,Buchanan WW ,Goldsmith CH ,Campbell J ,Stitt LW . Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833-40. [PMID:3068365 ] MedlineGoogle Scholar - 15.
Hurst NP ,Ruta DA ,Kind P . Comparison of the MOS short form-12 (SF12) health status questionnaire with the SF36 in patients with rheumatoid arthritis. Br J Rheumatol. 1998;37:862-9. [PMID:9734677 ] CrossrefMedlineGoogle Scholar - 16.
Ware J ,Kosinski M ,Keller SD . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220-33. [PMID:8628042 ] CrossrefMedlineGoogle Scholar - 17.
LaValley MP ,McLaughlin S ,Goggins J ,Gale D ,Nevitt MC ,Felson DT . The lateral view radiograph for assessment of the tibiofemoral joint space in knee osteoarthritis: its reliability, sensitivity to change, and longitudinal validity. Arthritis Rheum. 2005;52:3542-7. [PMID:16255043 ] CrossrefMedlineGoogle Scholar - 18.
Kellgren JH ,Lawrence JS . Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494-502. [PMID:13498604 ] CrossrefMedlineGoogle Scholar - 19.
Felson DT ,McAlindon TE ,Anderson JJ ,Naimark A ,Weissman BW ,Aliabadi P ,et al . Defining radiographic osteoarthritis for the whole knee. Osteoarthritis Cartilage. 1997;5:241-50. [PMID:9404469 ] CrossrefMedlineGoogle Scholar - 20.
Williams GN ,Snyder-Mackler L ,Barrance PJ ,Buchanan TS . Quadriceps femoris muscle morphology and function after ACL injury: a differential response in copers versus non-copers. J Biomech. 2005;38:685-93. [PMID:15713288 ] CrossrefMedlineGoogle Scholar - 21.
Arden NK ,Nevitt MC ,Lane NE ,Gore LR ,Hochberg MC ,Scott JC ,et al . Osteoarthritis and risk of falls, rates of bone loss, and osteoporotic fractures. Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1999;42:1378-85. [PMID:10403265 ] CrossrefMedlineGoogle Scholar - 22.
Felson DT . Obesity and vocational and avocational overload of the joint as risk factors for osteoarthritis. J Rheumatol Suppl. 2004;70:2-5. [PMID:15132347 ] MedlineGoogle Scholar - 23.
Felson DT ,Zhang Y . An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998;41:1343-55. [PMID:9704632 ] CrossrefMedlineGoogle Scholar - 24.
Fitzgerald GK ,Childs JD ,Ridge TM ,Irrgang JJ . Agility and perturbation training for a physically active individual with knee osteoarthritis. Phys Ther. 2002;82:372-82. [PMID:11922853 ] CrossrefMedlineGoogle Scholar
Author, Article, and Disclosure Information
From Boston University School of Medicine, Hebrew SeniorLife, Brigham and Women's Hospital, and Boston Medical Center, Boston, Massachusetts.
Acknowledgments: The authors thank the participants of the Framingham Osteoarthritis Study for helping them perform this study.
Grant Support: By grants AR47785 and AG18393 from the National Institutes of Health and contract N01-HC-25195 for the National Heart, Lung, and Blood Institute's Framingham Heart Study.
Disclosures: None disclosed.
Corresponding Author: David T. Felson, MD, MPH, Clinical Epidemiology Unit, Suite 200, Boston University School of Medicine, 650 Albany Street, Boston, MA 02118; e-mail, [email protected]
Current Author Addresses: Drs. Felson, Niu, Sack, Hunter, and Englund: Clinical Epidemiology Unit, Suite 200, Boston University School of Medicine, 650 Albany Street, Boston, MA 02118.
Ms. McClennan: Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131.
Dr. Aliabadi: Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Dr. Guermazi: Department of Radiology, 818 Harrison Avenue, Boston Medical Center, Boston, MA 02118.
Author Contributions: Conception and design: D.T. Felson, M. Englund.
Analysis and interpretation of the data: D.T. Felson, J. Niu, A. Guermazi, D.J. Hunter, M. Englund.
Drafting of the article: D.T. Felson.
Critical revision of the article for important intellectual content: J. Niu, C. McClennan, B. Sack, P. Aliabadi, A. Guermazi, D.J. Hunter, M. Englund.
Final approval of the article: C. McClennan, A. Guermazi.
Provision of study materials or patients: D.T. Felson, B. Sack.
Statistical expertise: J. Niu.
Obtaining of funding: D.T. Felson.
Administrative, technical, or logistic support: D.T. Felson, J. Niu, C. McClennan.
Collection and assembly of data: D.T. Felson, J. Niu, C. McClennan, B. Sack, P. Aliabadi.
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