Gait & posture · 2026
Multidomain gait and inter-limb asymmetry measures discriminate early knee osteoarthritis prior to radiographic change.
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Ganguly Apurba K, Banerjee Sudip K, G V Vidya Sagar, Singal Dinesh K, Ganguly Anondeep
Аннотация
BACKGROUND: Subtle gait alterations and inter-limb asymmetry may precede radiographic knee osteoarthritis (OA), but isolated biomechanical variables often lack sensitivity for early detection. We evaluated whether multidomain gait and strength measures improve discrimination of symptomatic individuals without radiographic OA.
METHODS: One hundred seventeen symptomatic participants with Kellgren-Lawrence grade 0 knees and 60 age-matched controls underwent assessment of walking speed, step length, knee sagittal-plane range of motion, functional mobility, and knee flexor and extensor strength. Inter-limb asymmetry indices were calculated and aggregated into a Composite Mechanical Dysfunction Index. Circulating inflammatory and tissue-turnover markers were analysed as adjunct physiological measures. Between-group differences were quantified using standardized mean differences and cross-validated receiver operating characteristic analyses.
FINDINGS: Compared with controls, symptomatic participants walked more slowly, had shorter step length, reduced knee range of motion, and greater mobility and strength asymmetry (all p < 0.001). Mechanical domains showed small-to-large effects (standardized mean differences up to approximately 1.05), with gait performance demonstrating the largest mechanical difference, whereas biological markers showed larger effects (up to ∼1.7). The composite mechanical index demonstrated excellent discrimination (cross-validated AUC 0.93-0.99). Addition of physiological markers yielded only modest improvement. A simplified four-domain mechanical model retained approximately 82% of full-model performance.
INTERPRETATION: Multidomain gait and asymmetry measures identify clinically meaningful functional impairment in individuals with knee symptoms despite normal radiographs. Composite mechanical metrics provide an interpretable and scalable approach for early screening and may support targeted preventive strategies.
METHODS: One hundred seventeen symptomatic participants with Kellgren-Lawrence grade 0 knees and 60 age-matched controls underwent assessment of walking speed, step length, knee sagittal-plane range of motion, functional mobility, and knee flexor and extensor strength. Inter-limb asymmetry indices were calculated and aggregated into a Composite Mechanical Dysfunction Index. Circulating inflammatory and tissue-turnover markers were analysed as adjunct physiological measures. Between-group differences were quantified using standardized mean differences and cross-validated receiver operating characteristic analyses.
FINDINGS: Compared with controls, symptomatic participants walked more slowly, had shorter step length, reduced knee range of motion, and greater mobility and strength asymmetry (all p < 0.001). Mechanical domains showed small-to-large effects (standardized mean differences up to approximately 1.05), with gait performance demonstrating the largest mechanical difference, whereas biological markers showed larger effects (up to ∼1.7). The composite mechanical index demonstrated excellent discrimination (cross-validated AUC 0.93-0.99). Addition of physiological markers yielded only modest improvement. A simplified four-domain mechanical model retained approximately 82% of full-model performance.
INTERPRETATION: Multidomain gait and asymmetry measures identify clinically meaningful functional impairment in individuals with knee symptoms despite normal radiographs. Composite mechanical metrics provide an interpretable and scalable approach for early screening and may support targeted preventive strategies.