Reduced Muscle Strength Can Alter the Impact of Gait Modifications on Knee Cartilage Mechanics

Muscle strength can substantially influence knee joint loading, stability, and cartilage biomechanics, all of which are important factors in the onset and progression of knee osteoarthritis (KOA). Noninvasive rehabilitation methods, such as gait modifications, are suggested to effectively alter knee joint loading, potentially helping to prevent or slow KOA progression. However, no studies to date have assessed if reduced lower limb muscle strength can influence the effects of rehabilitation exercises such as gait modifications. This study aimed to reveal how reducing the strength of three lower limb muscle groups (knee extensors, hip abductors, and ankle extensors) impacts the effects of gait modifications (Toe-out, Toe-in, and Wide gait) on knee cartilage stresses. We analyzed motion and ground reaction force data from seven healthy male participants using a musculoskeletal-finite element workflow, where we systematically reduced the isometric strength of the selected muscle groups in the musculoskeletal models. Our findings indicate that reductions in hip abductor and ankle extensor strength had the most pronounced impact on the effects of gait modifications on cartilage mechanics (maximum decrease of 6 percentage points (PP) in the changes of maximum principal stress). Overall, Toe-out gait was least affected by reduced muscle strength compared to other gait styles, although responses varied greatly between participants (0-14 percentage point differences). This study emphasizes the importance of considering participant-specific muscle strengths when designing personalized rehabilitation strategies such as gait modifications and provides theoretical insights into optimizing rehabilitation exercises for managing KOA based on a given motion and joint kinetics.