Pregnancy Results in Lasting Changes in Knee Joint Laxity

Overview

Journal PM R

Publisher Wiley

Specialties Emergency Medicine
Rehabilitation Medicine

Date 2018 Jul 3

PMID 29964215

Citations 7

Authors

Stacey R Chu

Elizabeth H Boyer

Bruce Beynnon

Neil A Segal

Affiliations

Soon will be listed here.

Abstract

Background: Altered joint laxity can contribute to joint dysfunction. Knee joint laxity has been shown to increase during pregnancy, but its long-term persistence is unknown.

Objective: To determine whether pregnancy leads to lasting increases in knee joint compliance and laxity that persist longer than 4 months postpartum.

Design: Prospective cohort study.

Setting: A motion analysis laboratory at an academic medical center.

Participants: Fifty healthy women in their first trimester of pregnancy (mean ± SD 29.2 ± 4.3 years old and baseline body mass index 26.0 ± 5.4 kg/m ) were recruited.

Intervention: End-range knee laxity and midrange joint compliance were measured during the first trimester and 19 ± 4 weeks postpartum. Anterior-posterior and varus-valgus laxity were measured using 3-dimensional motion tracking while applying forces and moments in each respective plane using the Vermont Knee Laxity Device. Nonlinear models were constructed to assess relations between applied forces and joint translation, comparing early pregnancy with postpartum.

Outcomes: Multiplanar knee laxity and compliance.

Results: Peak varus-valgus (20-22%; P = .001) and posterior translation (51%; P < .001) of the tibia relative to the femur decreased from baseline, with a concomitant decrease in laxity (P < .001) and compliance (P = .039) in the coronal plane and in the posterior direction in primiparous (P = .009) and multiparous (P = .014) women. For primiparous women, laxity (P < .001) and compliance (P = .009) increased in the anterior direction.

Conclusions: Pregnancy resulted in a lasting decrease in multiplanar knee laxity and compliance in the varus and posterior directions with an increase in anterior compliance. The effects of these changes in laxity and compliance of the passive stabilizers on knee loading patterns, articular contact stresses, and risk for osteoarthritis and other musculoskeletal disorders will require additional research.

Level Of Evidence: II.

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References

Shultz S, Shimokochi Y, Nguyen A, Schmitz R, Beynnon B, Perrin D . Measurement of varus-valgus and internal-external rotational knee laxities in vivo--Part I: assessment of measurement reliability and bilateral asymmetry. J Orthop Res. 2007; 25(8):981-8. DOI: 10.1002/jor.20397. View

Beynnon B, Fleming B, Labovitch R, Parsons B . Chronic anterior cruciate ligament deficiency is associated with increased anterior translation of the tibia during the transition from non-weightbearing to weightbearing. J Orthop Res. 2002; 20(2):332-7. DOI: 10.1016/S0736-0266(01)00115-2. View

Dumas G, Reid J . Laxity of knee cruciate ligaments during pregnancy. J Orthop Sports Phys Ther. 1997; 26(1):2-6. DOI: 10.2519/jospt.1997.26.1.2. View

Blecher A, Richmond J . Transient laxity of an anterior cruciate ligament-reconstructed knee related to pregnancy. Arthroscopy. 1998; 14(1):77-9. DOI: 10.1016/s0749-8063(98)70125-2. View

Segal N, Kern A, Anderson D, Niu J, Lynch J, Guermazi A . Elevated tibiofemoral articular contact stress predicts risk for bone marrow lesions and cartilage damage at 30 months. Osteoarthritis Cartilage. 2012; 20(10):1120-6. PMC: 3427397. DOI: 10.1016/j.joca.2012.05.013. View

Cooper C, Snow S, McAlindon T, Kellingray S, Stuart B, Coggon D . Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000; 43(5):995-1000. DOI: 10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1. View

Sah R, Kim Y, Doong J, Grodzinsky A, Plaas A, Sandy J . Biosynthetic response of cartilage explants to dynamic compression. J Orthop Res. 1989; 7(5):619-36. DOI: 10.1002/jor.1100070502. View

Heijink A, Gomoll A, Madry H, Drobnic M, Filardo G, Espregueira-Mendes J . Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2011; 20(3):423-35. PMC: 3282009. DOI: 10.1007/s00167-011-1818-0. View

Dehghan F, Haerian B, Muniandy S, Yusof A, Dragoo J, Salleh N . The effect of relaxin on the musculoskeletal system. Scand J Med Sci Sports. 2013; 24(4):e220-9. PMC: 4282454. DOI: 10.1111/sms.12149. View

10.

DAmbrosia R . Epidemiology of osteoarthritis. Orthopedics. 2005; 28(2 Suppl):s201-5. DOI: 10.3928/0147-7447-20050202-04. View

11.

Yoo H, Shin D, Song C . Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J Phys Ther Sci. 2015; 27(1):279-84. PMC: 4305582. DOI: 10.1589/jpts.27.279. View

12.

Vullo V, Richardson J, Hurvitz E . Hip, knee, and foot pain during pregnancy and the postpartum period. J Fam Pract. 1996; 43(1):63-8. View

13.

Wise B, Niu J, Zhang Y, Felson D, Bradley L, Segal N . The association of parity with osteoarthritis and knee replacement in the multicenter osteoarthritis study. Osteoarthritis Cartilage. 2013; 21(12):1849-54. PMC: 3855897. DOI: 10.1016/j.joca.2013.08.025. View

14.

Segal N, Anderson D, Iyer K, Baker J, Torner J, Lynch J . Baseline articular contact stress levels predict incident symptomatic knee osteoarthritis development in the MOST cohort. J Orthop Res. 2009; 27(12):1562-8. PMC: 2981407. DOI: 10.1002/jor.20936. View

15.

Schauberger C, Rooney B, Goldsmith L, Shenton D, Silva P, Schaper A . Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin levels. Am J Obstet Gynecol. 1996; 174(2):667-71. DOI: 10.1016/s0002-9378(96)70447-7. View

16.

Beardsley C, Howard A, Wisotsky S, Shafritz A, Beynnon B . Analyzing glenohumeral torque-rotation response in vivo. Clin Biomech (Bristol). 2010; 25(8):759-64. PMC: 2919603. DOI: 10.1016/j.clinbiomech.2010.06.006. View

17.

Schmitz R, Ficklin T, Shimokochi Y, Nguyen A, Beynnon B, Perrin D . Varus/valgus and internal/external torsional knee joint stiffness differs between sexes. Am J Sports Med. 2008; 36(7):1380-8. PMC: 2562882. DOI: 10.1177/0363546508317411. View

18.

Wada M, Imura S, Baba H, Shimada S . Knee laxity in patients with osteoarthritis and rheumatoid arthritis. Br J Rheumatol. 1996; 35(6):560-3. DOI: 10.1093/rheumatology/35.6.560. View

19.

Brage M, Draganich L, Pottenger L, Curran J . Knee laxity in symptomatic osteoarthritis. Clin Orthop Relat Res. 1994; (304):184-9. View

20.

Felson D, Zhang Y . An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998; 41(8):1343-55. DOI: 10.1002/1529-0131(199808)41:8<1343::AID-ART3>3.0.CO;2-9. View