Association between Leg Dominance and Symptom Onset in Knee Osteoarthritis: A Cross-sectional Study

Introduction: Knee Osteoarthritis (KOA) plays a substantial role in the global burden of musculoskeletal disorders. Biomechanical factors such as leg dominance are hypothesised to contribute to the onset and progression of KOA; however, the relationship between dominant limb use and symptom development remains unclear. Aim: To investigate the association between leg dominance and the onset and side of symptoms in KOA, utilising both a validated questionnaire and standardised functional task assessments. Materials and Methods: A cross-sectional study was conducted at the Department of Sports Physiotherapy, KLE Institute of Physiotherapy, Belagavi, Karnataka, India, over 11 months, from May 2024 to March 2025. It involved 131 individuals aged between 45 and 70 years with radiologically confirmed Grade I or II KOA. Leg dominance was assessed through a standardised questionnaire and six motor tasks. The data collected were compiled in Microsoft Excel and analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 29.0. Chi-square tests and t-tests were used to analyse associations. Results: A total of 131 participants (55 males and 76 females) were included in the final analysis. Right leg dominance was identified in 124 (94.7%) of the participants across all motor tasks, with a high concordance noted in the ball-kicking task between self-report and observation. Right knee pain was more common, reported by 111 (84.7%) participants, and the majority noted a gradual onset of symptoms, with 110 (84%) indicating this pattern. All left-leg dominant individuals were female and exhibited left-sided KOA (p-value <0.001). Sudden onset of symptoms was significantly associated with left-leg dominance, observed in 5 (71.4%) participants (p-value=0.001). Conclusion: The study identified a significant association between leg dominance and both the side and onset of KOA symptoms. Dominant limb mechanics may play a role in asymmetric joint loading and early symptom manifestation. Assessing leg dominance through both self-report and task observation may aid in the early identification of at-risk individuals and support targeted rehabilitation planning.