Knee thrust prevalence and normative hip-knee-ankle angle deviation values among healthy individuals across the lifespan

Osteoarthritis Cartilage. 2018 Oct;26(10):1326-1332. doi: 10.1016/j.joca.2018.06.009. Epub 2018 Jul 6.

Abstract

Objective: To report the prevalence of varus thrust and normative values for hip-knee-ankle (HKA) angle deviation across the lifespan, and to explore associations between HKA angle deviation and selected clinical factors.

Design: This was a cross-sectional observational study of 572 participants from the 1000 Norms Project, aged 3-101 years and who self-reported as being healthy. Video recordings (2D) of frontal plane gait were reviewed by physiotherapists for presence of knee thrust and quantification of HKA angle deviation (the difference between HKA angle at initial contact and mid-stance). Age and sex-stratified normative HKA angle deviation values were presented as means and 95% confidence intervals (CIs). Correlations were calculated between HKA angle and clinical measures (age, sex, body mass index (BMI), alignment, knee and hip strength, Knee Injury and Osteoarthritis Outcomes Scores (KOOS), foot posture index, temporo-spatial gait, and hypermobility).

Results: Overall, 31% of the cohort had varus thrust, most prevalent among adults older than 60 years (42%) and children aged 3-9 (41%). Varus thrust was common in adolescents (25%) and adults aged 20-59 (23%). Mean HKA angle deviation for the entire cohort was 1.2° (95%CI: 1.07, 1.36) towards varus, and 2.1° (95%CI: 1.84, 2.36) among people with clinical varus thrust. Weak associations were identified between HKA angle deviation and BMI, stride width, and KOOS-Sports among adolescents, and in adults weakly associated with height.

Conclusions: Prevalence of varus thrust is common across the lifespan. Normative values established here can be readily used by clinicians and researchers in monitoring this gait deviation.

Keywords: Biomechanics; Gait; Knee joint; Normative values; Osteoarthritis; Varus thrust.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomechanical Phenomena
  • Bone Malalignment / epidemiology
  • Bone Malalignment / etiology*
  • Bone Malalignment / physiopathology
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Gait / physiology
  • Humans
  • Incidence
  • Knee Joint / diagnostic imaging
  • Knee Joint / physiopathology*
  • Longevity*
  • Male
  • Middle Aged
  • New South Wales / epidemiology
  • Osteoarthritis, Knee / complications*
  • Osteoarthritis, Knee / diagnosis
  • Osteoarthritis, Knee / physiopathology
  • Radiography
  • Reference Values
  • Retrospective Studies
  • Video Recording
  • Young Adult