Falls associated with muscle strength in patients with knee osteoarthritis and self-reported knee instability

Objective. We aimed to evaluate the associations between knee muscle strength (MS) and falls, controlling for knee joint proprioception, varus-valgus knee joint laxity, and knee pain, among patients with knee osteoarthritis (OA) reporting knee instability. Methods. A sample of 301 subjects (203 women, 98 men, 35-82 yrs) with established knee OA and self-reported knee instability was studied. The occurrence of at least 1 fall in the previous 3 months was assessed by questionnaire. Maximum knee extension and flexion strength were measured isokinetically. Additionally, proprioception, varus-valgus laxity, and pain were assessed. Student t tests were used to assess differences between subgroups. The association of muscle strength and falls was calculated using univariate and multivariate logistic regression analysis. Results. Over 10% of the subjects (31 out of 301) reported a fall in the previous 3 months. High knee extension muscle strength (crude OR 0.3, 95% CI 0.1-0.8, p = 0.022) and high knee flexion muscle strength (crude OR 0.2, 95% CI 0.0-1.0, p = 0.048) were associated with a lower risk of falls. Proprioception and laxity did not confound this relationship. After adjusting for pain, extensor strength had an adjusted OR of 0.5 (95% CI 0.2-1.4, p = 0.212) for falls and flexor strength had an adjusted OR of 0.4 (95% CI 0.1-2.3, p = 0.312). Conclusion. High knee extension and flexion muscle strength decreased the risk of falls in patients with knee OA and self-reported knee instability. After considering the effect of pain, there was insufficient statistical power to detect an association between muscle strength and falls, which might be because of the low number of subjects who fell (n = 31).