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Document Title: Kerrigan-APMR-Sep00.shtml
Article Title: Knee Joint Torques: A Comparison Between Women and Men
During Barefoot Walking
Authors: D. Casey Kerrigan, MD, MS, Patrick O. Riley, PhD, Tanya J. Nieto, BA, Ugo
Della Croce, PhD
Publication: Archives of Physical Medicine and Rehabilitation
Date: September 2000
Volume 81, pages 1162-1165
Keywords: Knee torque, knee joint torque, women versus men, male, female, gender, walking, gait, ambulation, rehabilitation, anatomical, biomechanical, physiological, functional differences in knees between men and women, effect of high-heeled shoes.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables. This article, in addition to its references, also contains four footnotes, denoted by letters a through d.)
Comments: Kerrigan et al. found that women and men have very similar intrinsic biomechanical risks for knee osteoarthritis (where "intrinsic" is defined as being an inherent function of anatomy and physiology, and in practice is measured via barefoot walking). The authors astutely note that women are nearly twice as likely to develop knee osteoarthritis, and end up undergoing twice as many total knee replacement surgeries (arthroplasties). The major cause of this staggeringly huge spike in female osteoarthritis appears to be the widespread wearing of high-heeled footwear. However, the authors note, in the discussion section, that myriad other factors should also be borne in mind. (Note that females are also 2-8 times as likely to incur ACL tearing, in particular in the context of cutting-type [plant-and-twist] sports such as soccer and basketball. These factors are separate from the high-heeled footwear issue, since the female-ACL issue become apparent only rather recently, as female participation in knee-demanding sports skyrocketed starting in about the 1980s. Therefore, osteoarthritis in females arising as a direct consequence of ACL injuries has, as of 2000, not started to generate a pronounced need for total knee replacements. For this reason, it is unlikely that any of the total knee replacements referred to by Kerrigan in this 2000 study would be attributable to ACL injuries. This leaves high-heeled footwear as the most logical explanation for the markedly higher rate of total knee replacements in females, as compared to males. Further discussion on the effects of high heels can be found in two other articles by Kerrigan et al.: Kerrigan-TL-May98.shtml and Kerrigan-TL-Apr01.shtml.)
ABSTRACT
Objective: To determine if knee joint torques, which are likely relevant to the development and, possibly, progression of knee osteoarthritis, are equivalent between genders during natural, barefoot walking.
Design: Collected stereophotogrammetric and force platform data during comfortable, barefoot walking. Knee joint torques were plotted and statistically compared between genders using both an unpaired t test (p<.05) and an equivalence test (20% delta).
Setting: A gait laboratory.
Participants: One hundred ten healthy, non-disabled young women and men.
Main Outcome Measures: Four knee joint torque parameters normalized for height and weight: (1) peak and (2) duration of sagittal flexor joint torque from early to midstance, and (3) first and (4) second peak coronal (frontal) varus torque values during the stance period.
Results: No statistically significant differences between genders were found, and the values were equivalent between genders for each of the 4 knee joint torque parameters.
Conclusion: These findings support the hypothesis that under similar barefoot conditions women and men have a similar intrinsic biomechanical risk for knee osteoarthritis. Future research to assess the effects of other potential biomechanical factors, such as shoe-wear and activity type, may assist not only in preventing knee joint osteoarthritis, but also in developing new rehabilitative strategies to treat osteoarthritis of the knee.
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