Quadriceps Weakness and Risk of Knee Cartilage Loss Seen on Magnetic Resonance Imaging in a Population-based Cohort with Knee Pain.

OBJECTIVE: To determine whether baseline quadriceps weakness predicts cartilage loss assessed on magnetic resonance imaging (MRI).

METHODS: Subjects aged 40-79 with knee pain (n = 163) were recruited from a random population sample and examined for quadriceps weakness with manual isometric strength testing, using a 3-point scoring system (0 = poor resistance, 1 = moderate resistance, 2 = full resistance), which was dichotomized as normal (grade 2) versus weak (grade 0/1). MRI of the more symptomatic knee was obtained at baseline and at mean of 3.3 years. Cartilage was graded 0-4 on MRI. Exponential regression analysis was used to evaluate whether quadriceps weakness was associated with whole knee cartilage loss, and in secondary analyses with compartment-specific cartilage loss, adjusted for age, sex, body mass index, Western Ontario and McMaster Universities Osteoarthritis Arthritis Index pain score, and baseline MRI cartilage score.

RESULTS: Of 163 subjects, 54% were female, with a mean age of 57.7 years. Quadriceps weakness was seen in 11.9% of the subjects. Weakness was a predictor of whole knee cartilage loss (HR 3.48, 95% CI 1.30-9.35). Quadriceps weakness was associated with cartilage loss in the medial tibiofemoral (TF) compartment (HR 4.60, 95% CI 1.25-17.02), while no significant association was found with lateral TF (HR 1.53, 95% CI 0.24-9.78) or patellofemoral compartment (HR 2.76, 95% CI 0.46-16.44).

CONCLUSION: In this symptomatic, population-based cohort, quadriceps weakness predicted whole knee and medial TF cartilage loss after 3 years. To our knowledge, this is the first study to show that a simple clinical examination of quadriceps strength can predict the risk of knee cartilage loss.