Resistance Training for Medial Compartment Knee Osteoarthritis and Malalignment

KING, LAUREN K.1; BIRMINGHAM, TREVOR B.1,2; KEAN, CRYSTAL O.1; JONES, IAN C.1,2; BRYANT, DIANNE M.2; GIFFIN, J. ROBERT1

Medicine & Science in Sports & Exercise: August 2008 - Volume 40 - Issue 8 - pp 1376-1384
doi: 10.1249/MSS.0b013e31816f1c4a
CLINICAL SCIENCES: Clinically Relevant

Purposes: 1) To evaluate the effects of a 12-wk high-intensity knee extensor and flexor resistance training program on strength, pain, and adherence in patients with advanced knee osteoarthritis and varus malalignment and 2) to generate pilot data for change in dynamic knee joint load, patent-reported outcomes, and self-efficacy after training.

Methods: Fourteen patients (48.35 ± 6.51 yr) with radiographically confirmed medial compartment knee osteoarthritis and varus malalignment of the lower limb were recruited from a surgical waiting list for high tibial osteotomy. Participants completed a high-intensity isokinetic resistance training program three times per week for 12 wk. Knee extensor and flexor strength were assessed every third week, whereas pain and adherence were recorded at every training session. The external knee adduction moment during the gait, the 6-min-walk test, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Arthritis Self-Efficacy Scale (ASES) were also evaluated before and after training.

Results: Significant improvements in knee extensor and flexor strength were observed without increases in pain during or after training. Adherence to the high-intensity program was high. No significant changes were observed for dynamic knee joint load or the KOOS. There was a significant increase in the function subscale of the ASES only.

Conclusions: These findings suggest that patients with advanced knee osteoarthritis and malalignment can experience substantial gains in strength after a high-intensity resistance training program without concomitant increases in pain, adverse events, or compromised adherence. These findings provide support for future clinical trials with longer-term outcomes.

1Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, and 2School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, CANADA

Address for correspondence: Trevor B. Birmingham, Ph.D., School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada; E-mail: tbirming@uwo.ca.

Submitted for publication January 2008.

Accepted for publication February 2008.

©2008The American College of Sports Medicine