Quadriceps weakness and osteoarthritis of the knee

Charles Slemenda, Kenneth D. Brandt, Douglas K. Heilman, Steven Mazzuca, Ethan M. Braunstein, Barry P. Katz, Fredric D. Wolinsky

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670 Scopus citations


Background: The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis. Objective: To explore the relation between lower-extremity weakness and osteoarthritis of the knee. Design: Cross-sectional prevalence study. Setting: Population- based, with recruitment by random-digit dialing. Participants: 462 volunteers 65 years of age or older. Measurements: Radiographs of the knee were graded for the presence of osteoarthritis. Knee pain and function were assessed with the Western Ontario and McMaster Universities Arthritis Index, the strength of leg flexors and extensors was assessed with isokinetic dynamometry, and lower-extremity lean tissue mass was assessed with dual-energy x-ray absorptiometry. Results: Among participants with osteoarthritis, quadriceps weakness, but not hamstring weakness, was common. The ratio of extensor strength to body weight was approximately 20% lower in those with than in those without radiographic osteoarthritis. Notably, among women with tibiofemoral osteoarthritis, extensor weakness was present in the absence of knee pain and was seen in participants with normal lower-extremity lean mass (extensor strength, 30.1 lb-ft for those with osteoarthritis and 34.8 lb-ft for those without osteoarthritis; P < 0.001). After adjustment for body weight, age, and sex, lesser quadricaps strength remained predictive of both radiographic and symptomatic osteoarthritis of the knee (odds ratio for prevalence of osteoarthritis per 10 lb-ft loss of strength, 0.8 [95% Cl, 0.71 to 0.90] for radiographic osteoarthritis and 0.71 [Cl, 0.51 to 0.87] for symptomatic osteoarthritis). Conclusion: Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee.

Original languageEnglish (US)
Pages (from-to)97-104
Number of pages8
JournalAnnals of internal medicine
Issue number2
StatePublished - Jul 15 1997

ASJC Scopus subject areas

  • Internal Medicine

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    Slemenda, C., Brandt, K. D., Heilman, D. K., Mazzuca, S., Braunstein, E. M., Katz, B. P., & Wolinsky, F. D. (1997). Quadriceps weakness and osteoarthritis of the knee. Annals of internal medicine, 127(2), 97-104. https://doi.org/10.7326/0003-4819-127-2-199707150-00001