Knee Joint Laxity in a Native Canadian Indian Population

By Steinitz, Daniel K.; Harvey, Edward J. et al. | Canadian Journal of Public Health, May/June 2005 | Go to article overview

Knee Joint Laxity in a Native Canadian Indian Population


Steinitz, Daniel K., Harvey, Edward J., Berry, Gregory K., Reindl, Rudolf, Correa, José A., Canadian Journal of Public Health


ABSTRACT

Background: Clinical observation of increased laxity has been noted in native Canadians. Comparative studies support the possible relationship between joint hypermobility and the development of osteoarthritis or other joint ailments. If joint laxity predisposes to osteoarthritis, there may be far-reaching consequences to the general Native population.

Methods: A cohort of 52 Native Canadians (NC) and 52 non-Native Canadians (NNC) were evaluated for knee laxity. All patients had no prior history of knee injury or complaints of symptoms related to knee pathology at the time of the examination. Bilateral knee examination was performed. Objective laxity was measured using the KT-1 000 tensiometer. Subjective findings were also recorded.

Results: Comparison for instability between the groups (NC and NNC) revealed that the NC group had significantly greater laxity on both right and left sides for all knee ligament grading (p≤0.0001). The values for displacement during KT-1000 measurements were significantly greater in the NC group for all forces (p≤0.0001). Presence of all the following were also significantly greater in the NC group: pivot shift (p≤0.001); medial and lateral collateral ligament opening (p≤0.001 ); posterior cruciate drawer test (p≤0.001).

Interpretation: This prospective matched cohort reveals that there is a significant joint hypermobility in this Native Canadian population.

MeSH terms: joint hypermobility; Native population; osteoarthritis; prospective cohort

Case studies of patients with benign joint hypermobility syndrome suggest both a tendency toward osteopenia and an association with premature osteoarthritis (OA).1-11 Some data from comparative studies support the possible association between joint hypermobility and the development of articular complaints.4,6,11 It was noted, in clinical experience, that the Native Canadian population seen in our institution had increased joint laxity in all age groups. A non-controlled study has previously indicated that there may be increased joint laxity in Native Americans.12 It is well established that disabilities are under-diagnosed as well as under-treated in the Native Canadian population as a whole,13,14 although this may not be true in every treatment centre. If joint laxity predisposes to osteoarthritis, there may be far-reaching consequences to the general Native population. The northern Native population still reveres the hunter-gatherer, who has an exalted elder status. There is still a dependency on traditional food gathering in this population. Progressive limitations to mobility may decrease the ability of the tribe to gather food in a traditional sense. Predisposition to osteoarthritis and other joint ailments may have ramifications to the Native population in that this tendency has not been reported and may reflect treatment bias for this group. This current study evaluated whether the clinical sense that there was a tendency to joint laxity in the Native Canadian population in northern Canada was actually true. A group of Cree patients without knee pathology was compared to a group of non-Native patients without knee pathology. Comparison was performed between these two groups for knee joint laxity, symptoms and physical examination differences.

MATERIALS AND METHODS

A cohort of 52 Native Canadians (NC) and 52 non-Native Canadians (NNC) were evaluated for knee laxity. No patients were included in this study who fit the criteria of hypermobility syndrome (passive thumb apposition to touch the forearm; passive little finger hyperextension of more than 90 degrees; elbow hyperextension of more than 10 degrees; knee hyperextension of more than 10 degrees; forward flexion of the trunk with the knees straight and the palms of the hands resting flat on the floor).15 Patients were matched for sex. All patients had no prior history of knee injury and had no complaints of symptoms related to knee pathology, instability or other, at the time of the examination. …

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