David T. Felson, MD, MPH; Jingbo Niu, DS; Christine McClennan, MPH; Burton Sack, MD; Piran Aliabadi, MD; David J. Hunter, MD, PhD; Ali Guermazi, MD; Martin Englund, MD, PhD
Acknowledgments: The authors thank the participants of the Framingham Osteoarthritis Study for helping them perform this study.
Grant Support: By grants AR47785 and AG18393 from the National Institutes of Health and contract N01-HC-25195 for the National Heart, Lung, and Blood Institute's Framingham Heart Study.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: David T. Felson, MD, MPH, Clinical Epidemiology Unit, Suite 200, Boston University School of Medicine, 650 Albany Street, Boston, MA 02118; e-mail, email@example.com.
Current Author Addresses: Drs. Felson, Niu, Sack, Hunter, and Englund: Clinical Epidemiology Unit, Suite 200, Boston University School of Medicine, 650 Albany Street, Boston, MA 02118.
Ms. McClennan: Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131.
Dr. Aliabadi: Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Dr. Guermazi: Department of Radiology, 818 Harrison Avenue, Boston Medical Center, Boston, MA 02118.
Author Contributions: Conception and design: D.T. Felson, M. Englund.
Analysis and interpretation of the data: D.T. Felson, J. Niu, A. Guermazi, D.J. Hunter, M. Englund.
Drafting of the article: D.T. Felson.
Critical revision of the article for important intellectual content: J. Niu, C. McClennan, B. Sack, P. Aliabadi, A. Guermazi, D.J. Hunter, M. Englund.
Final approval of the article: C. McClennan, A. Guermazi.
Provision of study materials or patients: D.T. Felson, B. Sack.
Statistical expertise: J. Niu.
Obtaining of funding: D.T. Felson.
Administrative, technical, or logistic support: D.T. Felson, J. Niu, C. McClennan.
Collection and assembly of data: D.T. Felson, J. Niu, C. McClennan, B. Sack, P. Aliabadi.
Felson DT, Niu J, McClennan C, Sack B, Aliabadi P, Hunter DJ, et al. Knee Buckling: Prevalence, Risk Factors, and Associated Limitations in Function. Ann Intern Med. 2007;147:534-540. doi: 10.7326/0003-4819-147-8-200710160-00005
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Published: Ann Intern Med. 2007;147(8):534-540.
Knee buckling is the sudden loss of postural support across the knee at a time of weight bearing. Affected persons often characterize this phenomenon as “giving way.” One study has suggested that the prevalence of knee buckling is high in selected persons seeking physical therapy and stability training for knee osteoarthritis (1). However, the prevalence of knee buckling in the community and its effect on physical function have not been described.
Buckling occurs mostly in persons with knee pain, and frequent knee pain affects about 25% of adults (2). Many of these persons have osteoarthritis of the knee (3). Whereas buckling and instability are a focus of orthopedic literature, these phenomena are neglected in medicine textbooks in chapters on knee pain or osteoarthritis (4, 5). When buckling is discussed, it is identified as evidence of an internal derangement, such as an anterior cruciate ligament (ACL) tear (5). A search of MEDLINE for articles on knee instability (subject), buckling, or giving way (words in title or abstract) from 1966 through June 2007 revealed that articles on knee buckling or instability were found almost exclusively in the orthopedic literature, where it was noted as a complication of surgery (6, 7); a hallmark symptom of ACL tear (8); or a consequence of specific, uncommon conditions, such as patellar dislocation (9). Thus, buckling is not generally described in native, uninjured knees.
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