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Older people who have symptoms of knee instability may be at an increased risk of falls and fractures, according to a study published in Arthritis Care & Research, a journal of the American College of Rheumatology.

Knee buckling — when a knee “gives way” — is a symptom of knee instability that frequently affects older individuals, especially those with knee pain and knee osteoarthritis (OA). It may be caused by muscle weakness and balance difficulties, the researchers said.

To investigate the potential link betwen knee instability and falls, Dr. Michael Nevitt of the University of California, San Francisco, and his colleagues prospectively studied 1,842 participants in the Multicenter Osteoarthritis Study (MOST) who were an average of 67 years old at the start and who had, or were at high risk for, knee osteoarthritis.

After five years, one in six participants (16.8%) reported knee buckling, and at the end of seven years, one in seven (14.1%) had recurrent (at least two) falls.

Results showed that those with knee buckling at year five had a 1.6- to 2.5-times higher likelihood of recurrent falls, fear of falling, and poor balance confidence at year seven. Those who fell when a knee buckled at the start of the study had a 4.5-times higher likelihood two years later of recurrent falls, as well as double the likelihood of significant fall injuries and 3-times higher likelihood of fall injuries that limited activity. They were also 4-times more likely to have poor balance.

The findings suggest that interventions that reduce knee buckling, such as targeted exercises, may help prevent falls, fall-related injuries and adverse psychological consequences of falls in patients with knee OA.

“Falls, injury from falls and poor balance confidence are extremely common and debilitating problems in older people,” commented Dr. Nevitt. “The present study has demonstrated for the first time that knee instability and knee buckling are important causes of these problems in the very large segment of the older population suffering from knee pain.”

He concluded: “The most important immediate impact of these findings on patient care is that health professionals should query their patients with knee OA about instability, buckling and falls, and work with them to take preventive actions, including proper use of walking aids, leg strengthening and appropriate footwear.”