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Association between imbalanced lower extremity muscle quality and the development of knee osteoarthritis: a Systematic Review and meta-analysis
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DOI：10.3389/fphys.2026.1886678.png)
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Abstract
En 中文
BackgroundKnee osteoarthritis (KOA) is the most prevalent musculoskeletal degenerative disease worldwide. Periarticular muscle abnormalities are considered closely associated with its pathogenesis; yet the relationships between various muscle parameters and KOA remain controversial.ObjectiveTo clarify the correlations of thigh muscle quantity; muscle quality; and muscle strength with KOA through a systematic review and meta-analysis; and to provide evidence-based support for the risk screening and early intervention of KOA in high-risk populations.MethodsRelevant cross-sectional; cohort; and case-control studies published up to March 2026 were searched in PubMed; Embase; and MEDLINE (accessed via the Ovid). Methodological quality was assessed using the AHRQ scale for cross-sectional studies and the Newcastle-Ottawa Scale for cohort and case-control studies. Meta-analyses were performed using RevMan 5.3 software; and subgroup analyses stratified by study design were conducted to explore sources of heterogeneity.ResultsA total of 24 studies involving 10; 300 participants were included. Patients with KOA showed significantly increased cross-sectional areas of sartorius muscle (SMD = 0.09; P = 0.002) and flexor muscles (SMD = 0.09; P = 0.0008); and markedly reduced thickness of vastus lateralis muscle (SMD=-0.61; P = 0.03). Intermuscular adipose tissue content was significantly higher in KOA patients than in healthy controls (SMD = 0.35; P = 0.001). For muscle strength; KOA patients exhibited significant reductions in knee extensor torque (SMD=-1.09; P = 0.0001); extensor strength (SMD=-0.16; P = 0.0002); knee extensor relative strength (SMD=-0.15; P = 0.04); flexor torque (SMD=-0.95; P = 0.04); and flexor strength (SMD=-0.12; P = 0.004). Substantial heterogeneity was observed in key outcomes including knee extensor torque (I²=97%); knee flexor torque (I²=99%) and intermuscular adipose tissue (I²=72%). Low knee extensor strength was associated with a 1.45-fold increased odds of KOA (OR = 1.45; P = 0.01); and this association was more prominent in women (OR = 1.54; P = 0.0006).ConclusionAlterations in thigh muscle quantity; quality and strength are significantly associated with KOA; particularly increased intermuscular adipose tissue infiltration and decreased knee extensor strength. Current evidence is predominantly derived from cross-sectional and case-control studies; and causal inferences cannot be established. These muscle parameters may serve as potential indicators for KOA risk stratification; and their predictive value and clinical utility require further verification in large-scale prospective cohort studies.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261350323; identifier CRD420261350323.
Keywords:
systematic review
meta-analysis
knee osteoarthritis
muscle strength
muscle quantity
muscle quality
intermuscular adipose tissue
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