Passive stiffness of the quadriceps predicts the incidence of clinical knee osteoarthritis in twelve months

Zongpan Li, Kam L. Leung, Chen Huang, Xiuping Huang, Raymond Chung, Siu N. Fu (Corresponding Author)

Research output: Journal article publicationJournal articleAcademic researchpeer-review

2 Citations (Scopus)


BACKGROUND: Quadriceps weakness is a known risk factor for the onset of knee osteoarthritis (OA). In addition to muscle weakness, increased passive stiffness of the quadriceps may affect knee biomechanics and hence contribute to the pathogenesis of knee OA. However, the association between quadriceps stiffness and the risk of knee OAdevelopment has not been prospectively investigated. AIM: The aim of this study was to investigate how baseline quadriceps passive stiffness predicts the incidence of clinical knee OAat the 12-month follow-up. DESIGN: Prospective cohort study. SETTING: University laboratory. POPULATION: Community-dwelling adults aged 60-80 years were recruited. We excluded participants with: 1) knee pain or known arthritis; 2) knee injury; 3) knee or hip joint replacement, 4) cognitive impairment; or 5) neurological conditions. METHODS: At baseline, passive stiffness of the three superficial quadriceps muscle heads (rectus femoris [RF], vastus lateralis [VL], and vastus medialis oblique [VMO]) was evaluated using shear-wave ultrasound elastography. Knee muscle (quadriceps and hamstrings) strength was tested using a Cybex dynamometer. Knee OA was defined based on clinical criteria 12 months after baseline measurements. Generalized estimating equations were used to examine the associations of quadriceps stiffness and knee muscle strength with the risk of knee OA, controlling for age, sex, Body Mass Index, comorbidities, and activity level. RESULTS: The analyses included 158 knees (58.2% females, age: 65.6±4.1 years). Twenty-eight knees (17.7%) were classified as having clinical OAat 12 months. Compared with the lowest stiffness tertiles, the highest stiffness tertiles of the RF(relative risk =5.31, 95% CI: 1.34-21.0), VMO (4.15, 1.04-16.6), and total superficial quadriceps (6.35, 1.48-27.3) at baseline were significantly associated with a higher risk of knee OA at the follow-up. The highest strength tertile of quadriceps has a trend of association with a lower risk of knee OAthan the lowest tertile (0.18, 0.03-1.25, P=0.083). CONCLUSIONS: Greater passive stiffness of the quadriceps at baseline was associated with a higher risk of clinical knee OAincidence at the 12-month follow-up.

Original languageEnglish
Pages (from-to)65-74
Number of pages10
JournalEuropean Journal of Physical and Rehabilitation Medicine
Issue number1
Publication statusPublished - Feb 2023


  • knee
  • Muscle strength
  • Osteoarthritis
  • Quadriceps muscle

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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