Alterations in the Functional Knee Alignment Are Not an Effective Strategy to Modify the Mediolateral Distribution of Knee Forces During Closed Kinetic Chain Exercises

Abstract

Pain felt while performing rehabilitation exercises could be a reason for the low adherence of knee osteoarthritis patients to physical rehabilitation. Reducing compressive forces on the most affected knee regions may help to mitigate the pain. Knee frontal plane positioning with respect to pelvis and foot (functional knee alignment) has been shown to modify the mediolateral distribution of the tibiofemoral joint contact force in walking. Hence, different functional knee alignments could be potentially used to modify joint loading during rehabilitation exercises. The aim was to understand whether utilizing different alignments is an effective strategy to unload specific knee areas while performing rehabilitation exercises. Eight healthy volunteers performed 5 exercises with neutral, medial, and lateral knee alignment. A musculoskeletal model was modified for improved prediction of tibiofemoral contact forces and used to evaluate knee joint kinematics, moments, and contact forces. Functional knee alignment had only a small and inconsistent effect on the mediolateral distribution joint contact force. Moreover, the magnitude of tibiofemoral and patellofemoral contact forces, knee moments, and measured muscle activities was not significantly affected by the alignment. Our results suggest that altering the functional knee alignment is not an effective strategy to unload specific knee regions in physical rehabilitation.