Body mass affects kinetic symmetry and inflammatory markers in adolescent knees during gait

Sarah P Shultz; Ashley N Buck; Philip W Fink; Stacey M Kung; Mary J Ward; Zoltan Antal; Sherry I Backus; Andrew P Kraszewski; Howard J Hillstrom

doi:10.1016/j.clinbiomech.2023.105887

Body mass affects kinetic symmetry and inflammatory markers in adolescent knees during gait

Clin Biomech (Bristol, Avon). 2023 Feb:102:105887. doi: 10.1016/j.clinbiomech.2023.105887. Epub 2023 Jan 11.

Authors

Sarah P Shultz¹, Ashley N Buck², Philip W Fink³, Stacey M Kung⁴, Mary J Ward⁵, Zoltan Antal⁶, Sherry I Backus⁷, Andrew P Kraszewski⁸, Howard J Hillstrom⁹

Affiliations

¹ Kinesiology Department, Seattle University, Seattle, WA, USA. Electronic address: shultzsarah@seattleu.edu.
² Kinesiology Department, Seattle University, Seattle, WA, USA. Electronic address: abuck@seattleu.edu.
³ STAPS, Université Sorbonne Paris Nord, Bobigny, France; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France. Electronic address: philipwilliam.fink@sorbonne-paris-nord.fr.
⁴ Sports Medicine Department, Sports Surgery Clinic, Dublin, Ireland. Electronic address: staceykung@sportssurgeryclinic.com.
⁵ Weill Cornell Medicine, Department of Pediatrics, New York, NY, USA. Electronic address: mjward@med.cornell.edu.
⁶ Weill Cornell Medicine, Department of Pediatrics, New York, NY, USA. Electronic address: zoa9003@med.cornell.edu.
⁷ Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA. Electronic address: backuss@hss.edu.
⁸ Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA. Electronic address: kraszewskia@hss.edu.
⁹ Leon Root, MD Motion Analysis Laboratory, Rehabilitation Department, Hospital for Special Surgery (HSS), New York, NY, USA. Electronic address: hillstromh@hss.edu.

Abstract

Background: Early-onset osteoarthritis has been attributed to pro-inflammatory factors and biomechanical changes in obesity. However, research has yet to explore whether knee joint moments are asymmetrical in children with obesity and could precede the onset of knee osteoarthritis. The present study compares knee moment asymmetry between adolescents with and without obesity and examines the relationship between asymmetries and inflammatory biomarkers.

Methods: Twenty-eight adolescents (13-16 years) were classified as with (n = 12) or without (n = 16) obesity. Lower extremity kinetics were measured using three-dimensional motion analysis. Bilateral knee joint moments were analyzed in the sagittal, frontal, and transverse planes across stance phase. Kinetic asymmetry was calculated between the right and left sides and represented by the R² value. Enzyme-linked immunosorbent assays analyzed serum 25-hydroxy vitamin D, interferon gamma, tumor nercrosis factor alpha, interleukin-6, and C-reactive protein levels. Parametric and non-parametric tests determined significant group differences in asymmetries and biomarkers, respectively. Spearman's correlations identified relationships between biomarkers and asymmetries with statistically significant group differences.

Findings: Adolescents with obesity had greater sagittal (loading, midstance) and frontal (midstance, pre-swing) plane kinetic knee asymmetry and higher concentrations of interleukin-6 and C-reactive protein. A moderately negative correlation existed between C-reactive protein and sagittal (loading, midstance) plane asymmetry, and also between interleukin-6 and frontal (pre-swing) plane asymmetry.

Interpretation: Inflammatory response increases with greater knee joint asymmetry, suggesting knee joint damage and altered joint loading co-exist in adolescents with obesity. Increased risk to joint health may exist in sub-phases where knee joints are improperly loaded.

Keywords: Asymmetry; Child obesity; Inflammatory biomarkers; Kinetics; Lower extremity.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Biomechanical Phenomena
C-Reactive Protein
Child
Gait / physiology
Humans
Interleukin-6
Knee Joint / physiology
Pediatric Obesity*
Walking* / physiology

Substances

C-Reactive Protein
Interleukin-6

Grants and funding

UL1 TR002384/TR/NCATS NIH HHS/United States