joost dekker phd department of psychiatry & department of rehabilitation medicine vu university...

Joost Dekker PhDDepartment of Psychiatry & Department of Rehabilitation MedicineVU University Medical Center, Amsterdam, Netherlands

Knikkende knieënOver instabiliteit en loopvaardigheid bij

artrose van de knie

1

Osteoarthritis

• Prevalence symptomatic OA in among adults aged ≥45 years– Knee 16.7% – Hip 9.2%

• Top 10 of most disabling diseases in European region

• Most important cause of pain and disability in the

elderly

Jordan et al, 2007

WHO, 2008

Conaghan et al, 2008

• Impairments of cartilage and bone– Findings on X-rays, MRI

• Physical impairments– Muscle weakness, instability

• Sensory impairments– Pain, stiffness, instability

• Activity limitations– Walking, rising

• Problems in participation– Work

Osteoarthritis – multiple levels

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• Impairments of cartilage and bone– Findings on X-rays, MRI

• Physical impairments– Muscle weakness, instability

• Sensory impairments– Pain, stiffness, instability

• Activity limitations– Walking, rising

• Problems in participation– Work

Osteoarthritis – multiple levels

4

Instability

• Sudden loss of postural support across the knee at a time a weight bearing

• Self report – Sensation of buckling, shifting, or giving way of the knee– Sensory impairment

• Observed measure– To be developed– Physical impairment

5

Felson et al, 2007

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Instability

• In knee OA– 60 – 80 %

• Instability is associated with activity limitations– Walking speed, self reported walking limitations

7

Fitzgerald et al, 2004

Schmitt et al, 2008

van der Esch et al, 2012

Knoop et al, 2012

Nguyen et al, 2014

Instability

• In knee OA– 60 – 80 %

• Instability is associated with activity limitations

• … and with falls

8

Fitzgerald et al, 2004

Schmitt et al, 2008

van der Esch et al, 2012

Knoop et al, 2012

Nguyen et al, 2014

9

Instability

• Reduced muscle strength is associated with instability• Quadriceps and hamstring muscles are stabilizers of the knee

10

Knoop et al, 2012

11

van der Esch et al, 2006

Proprioception - perception of position and movement

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muscle strength Nm/kg

2,52,01,51,0,50,0

wal

k-tim

e (1

00 m

) se

c.

220

200

180

160

140

120

100

80

60

40

proprioception

poor

accurate

muscle strength Nm/kg

2,52,01,51,0,50,0

GU

G-ti

me

sec.

50

40

30

20

10

0

proprioception

poor

accurate

muscle strength Nm/kg

2,52,01,51,0,50,0

WO

MAC

-PF

scor

e

60

50

40

30

20

10

0

proprioception

poor

accurate

Muscle strength, proprioception and activity limitations

van der Esch et al, 2007

Replication Holla et al, 201213

14

Pain

15

Felson et al, 2007

Arthrogenic muscle inhibition

16

Stokes and Young, 1984

Tactile stimulation

• Lack (-/-) tactile stimulation – Instability ?

17

Arthrogenic muscle inhibition

18

Rice and McNair, 2010

Tactile stimulation

• Lack tactile stimulation (-/-) – Instability ?

• Additional tactile stimulation (+/+) – Soft brace

19

Additional tactile stimulation

20

Pegoretti et al, 2015

21

Instability in knee OA

• Highly prevalent– 60 – 80 %

• Activity limitations (walking), falls

• Muscle strength

• Proprioception• Pain• Tactile stimulation

22

Instability in knee OA

• Highly prevalent– 60 – 80 %

• Activity limitations (walking), falls

• Muscle strength

• Proprioception• Pain• Tactile stimulation

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Exercise therapy

Soft brace

Further information

j.dekker@vumc.nl

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