Ann Rheum Dis 1998;57:588-594 ( October )

Extended reports

Quadriceps weakness in knee osteoarthritis: the effect on pain and disability Sheila C O'Reilly,^a Adrian Jones,^a Ken R Muir,^b Michael Doherty^a

^a Rheumatology Unit, City Hospital, Nottingham NG5 1PB, ^b Department of Public Health Medicine and Epidemiology, Queens Medical Centre, Nottingham

Correspondence to: Dr O'Reilly.

Accepted for publication 27 July 1998

OBJECTIVES(1) To determine the importance of quadriceps strength, structural change, and psychological status in terms of knee pain in the community. (2) To determine the relative importance of quadriceps function, structural change, and psychological status with respect to disability in subjects with knee pain.
METHODS300 men and women with pain and 300 controls without pain (aged 40-79) were seen. Isometric quadriceps strength (MVC) was measured and muscle activation was assessed by twitch superimposition. Disability (Western Ontario McMaster Osteoarthritis Index (WOMAC)) and anxiety and depression were assessed (Hospital Anxiety and Depression Index (HAD)). Radiographs were obtained of the tibiofemoral and patellofemoral joints and total score for osteophyte, narrowing, and sclerosis calculated for each knee.
RESULTSSubjects with knee pain had lower voluntary quadriceps strength than those without pain (p<0.005). Quadriceps activation was also lower (p<0.005), but did not fully explain the reduction in strength. When analysed by multiple logistic regression: quadriceps strength (odds ratio 18.8, CI 4.8, 74.1 for MVC 10 kgF); depression (odds ratio 2.4, CI 1.0, 5.5 for HAD score8); and radiographic change (odds ratio 4.1, CI 1.9, 8.6 for radiographic score 4) were independently associated with pain. In those with knee pain, disability was independently associated with quadriceps strength (odds ratio 8.2, CI 1.5, 44.4 for MVC 10 kgF) and depression (odds ratio 6.2, CI 2.1, 18.0 for HAD score8); but not with radiographic score.
CONCLUSIONSQuadriceps strength is strongly associated with knee pain and disability in the community, even when activation and psychological factors are taken into account. This has important therapeutic implications.

Keywords: quadriceps; osteoarthritis; pain; disability

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© 1998 by Annals of the Rheumatic Diseases
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