The Importance of Knee Buckling

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The Importance of Knee Buckling

More than 10% of adults reported knee buckling in the past 3 months.

The prevalence of knee buckling, or "giving way," in general populations has not been well characterized. In a cross-sectional, population-based study, experience with this condition was assessed among members of the Framingham Offspring Study; this cohort was supplemented with other Framingham residents recruited through random-digit dialing.

Of 2351 participants (age range, 36–94), 12% reported at least one episode of knee buckling in the past 3 months. Of those who experienced buckling, most (78%) reported more than one episode, and 13% reported falling during an episode. Buckling occurred most commonly during these activities: walking, stair climbing, and twisting or turning. Pain, higher body-mass index, worse physical function, and quadriceps weakness were associated with buckling. In analyses adjusted for pain, buckling remained correlated with limitations in stair climbing and work. Although knee pain was associated with buckling, most people who reported buckling did not have radiographic knee osteoarthritis. Among those who underwent magnetic resonance imaging, 12% of those with buckling, versus 4% without, had anterior cruciate ligament tears.

Comment: These results confirm that a patient complaint familiar to physicians from the exam room, but not discussed much in the literature, is in fact common. Despite this study’s inability to assign causality, some of the identified associations suggest quadriceps strengthening and weight loss as potential interventions. Given the largely negative MRI findings, the etiology remains unclear for most patients with this problem, although the authors suggest rehabilitative efforts to address the instability.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine November 6, 2007

Citation(s):

Felson DT et al. Knee buckling: Prevalence, risk factors, and associated limitations in function. Ann Intern Med 2007 Oct 16; 147:534.

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