SynthesisBMJ open2014
Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials.
Synthesis in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 58 citations in OpenAlex.
- Assessment of causal link between psychological factors and symptom exacerbation in inflammatory bowel disease: a systematic review utilising Bradford Hill criteria and meta-analysis of prospective cohort studies.Systematic reviews · 2020Pooled it
- Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis - a systematic review and meta-analysis.BMC musculoskeletal disorders · 2018Pooled it
- Impact of therapeutic exercises on pain-related outcomes in patients with knee osteoarthritis: an umbrella review of 116 systematic reviews.Frontiers in pain research (Lausanne, Switzerland) · 2026Review
- Knee muscle strength and movement biomechanics in individuals with and without knee pain after anterior cruciate ligament reconstruction: A cross-sectional study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- The relation of walking forces to structural damage in the knee: The Multicenter Osteoarthritis Study.Osteoarthritis and cartilage · 2025Article
- Predicting Knee Joint Contact Force Peaks During Gait Using a Video Camera or Wearable Sensors.Annals of biomedical engineering · 2024Article
- Article
- Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis.Bioengineering (Basel, Switzerland) · 2024Review
- Prediction of Knee Joint Compartmental Loading Maxima Utilizing Simple Subject Characteristics and Neural Networks.Annals of biomedical engineering · 2023Article
- Efficacy of the SOAR knee health program: protocol for a two-arm stepped-wedge randomized delayed-controlled trial.BMC musculoskeletal disorders · 2022Article
- Predicting the Internal Knee Abduction Impulse During Walking Using Deep Learning.Frontiers in bioengineering and biotechnology · 2022Article
- Daily Walking and the Risk of Knee Replacement Over 5 Years Among Adults With Advanced Knee Osteoarthritis in the United States.Archives of physical medicine and rehabilitation · 2021Observational
- Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training.The American journal of sports medicine · 2021Article
- A novel walking cane with haptic biofeedback reduces knee adduction moment in the osteoarthritic knee.Journal of biomechanics · 2021Article
- Relative difference in muscle strength between patients with knee osteoarthritis and healthy controls when tested bilaterally and joint-inclusive: an exploratory cross-sectional study.BMC musculoskeletal disorders · 2019Article
- Chondroprotective Factors in Osteoarthritis: a Joint Affair.Current rheumatology reports · 2019Review
- Loneliness and social isolation causal association with health-related lifestyle risk in older adults: a systematic review and meta-analysis protocol.Systematic reviews · 2019Article
- Harmonising data collection from osteoarthritis studies to enable stratification: recommendations on core data collection from an Arthritis Research UK clinical studies group.Rheumatology (Oxford, England) · 2016Review
- State of the evidence.Current opinion in rheumatology · 2015Review
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveWe performed a systematic review, meta-analysis and assessed the evidence supporting a causal link between knee joint loading during walking and structural knee osteoarthritis (OA) progression.
designSystematic review, meta-analysis and application of Bradford Hill's considerations on causation. DATA SOURCES: We searched MEDLINE, Scopus, AMED, CINAHL and SportsDiscus for prospective cohort studies and randomised controlled trials (RCTs) from 1950 through October 2013. STUDY ELIGIBILITY CRITERIA: We selected cohort studies and RCTs in which estimates of knee joint loading during walking were used to predict structural knee OA progression assessed by X-ray or MRI. DATA ANALYSES: Meta-analysis was performed to estimate the combined OR for structural disease progression with higher baseline loading. The likelihood of a causal link between knee joint loading and OA progression was assessed from cohort studies using the Bradford Hill guidelines to derive a 0-4 causation score based on four criteria and examined for confirmation in RCTs.
resultsOf the 1078 potentially eligible articles, 5 prospective cohort studies were included. The studies included a total of 452 patients relating joint loading to disease progression over 12-72 months. There were very serious limitations associated with the methodological quality of the included studies. The combined OR for disease progression was 1.90 (95% CI 0.85 to 4.25; I(2)=77%) for each one-unit increment in baseline knee loading. The combined causation score was 0, indicating no causal association between knee loading and knee OA progression. No RCTs were found to confirm or refute the findings from the cohort studies.
conclusionsThere is very limited and low-quality evidence to support for a causal link between knee joint loading during walking and structural progression of knee OA. TRIAL REGISTRATION NUMBER: CRD42012003253.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.