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Title: Exploring the relationship between pain intensity and knee moments in participants with medial knee osteoarthritis : a cross-sectional study
Authors: Huang, C 
Chan, PK
Chiu, KY
Yan, CH
Yeung, SS
Fu, SN 
Issue Date: 2021
Source: BMC musculoskeletal disorders, 2021, v. 22, 685
Abstract: Background: High biomechanical loading is believed to be a risk factor to pain in people with knee osteoarthritis (OA), but controversial findings have been reported on the relationship between external knee adduction moment (KAM) and pain. A more comprehensive analysis considering other factor such as external knee flexion moment (KFM) could help better reveal this relationship. This study explored the relationship between external knee adduction moment and pain intensity in participants with knee osteoarthritis (OA) using an integrated path analysis model.
Methods: This was a cross-sectional study based on laboratory setting. Forty-seven participants with clinical and radiographic medial knee OA were analyzed for their external knee adduction moment (KAM) and knee flexion moment (KFM) during walking using a motion analysis system. Pain intensity was measured by visual analogue scale (VAS) and the pain subscale of the Knee Injury and Osteoarthritis Outcome Score. Varus/valgus alignment was captured and quantified using a bi-planar X-ray system. Using a path analysis model, the relationships between pain intensity, KAM, KFM, OA radiographic severity, knee varus angle and walking speed were examined.
Results: The proposed path model met the goodness-of-fit criteria. Based on this model, KAM had a negative effect on VAS pain indirectly through the mediation of KFM. The model indicated KAM and KFM were negatively related to one another; and KFM was positively related to VAS. The KAM index, defined as (KAM/ (KAM + KFM)), was negatively related to VAS.
Conclusions: Path analysis enabled the construction of a more integrated pathokinematic framework for people with knee OA. The KAM index which reflected the load sharing on the frontal and sagittal planes also revealed its relationship with pain. Re-distribution of mechanical loading from frontal to sagittal plane might be a strategy for pain avoidance associated with mechanical irritation.
Keywords: External knee adduction moment
Knee osteoarthritis
Publisher: BioMed Central
Journal: BMC musculoskeletal disorders 
EISSN: 1471-2474
DOI: 10.1186/s12891-021-04587-w
Rights: © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit Creative Commons Public Domain Dedication waiver ( applies to thedata made available in this article, unless otherwise stated in a credit line to the data.
The following publication Huang, C., Chan, PK., Chiu, KY. et al. Exploring the relationship between pain intensity and knee moments in participants with medial knee osteoarthritis: a cross-sectional study. BMC Musculoskelet Disord 22, 685 (2021) is available at
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