Characterization of knee dysfunction and related risk factors during pregnancy

Miho J. Tanaka, Jared M. Forman, Alexandra G. Otwell, Leah D. Frischmann, Lynne C. Jones, Linda M. Szymanski

Research output: Contribution to journalArticlepeer-review


Background: Knee pain can be a common complaint during pregnancy; however, the severity of symptoms and their associated risk factors have not been described. Questions/purposes: The aim of this study was to characterize knee-related dysfunction and describe risk factors in a general obstetric population. Patients and methods: Patients in obstetric clinics completed the International Knee Documentation Committee (IKDC) questionnaire to assess their knee function, as well as the Pregnancy Physical Activity Questionnaire (PPAQ), a validated tool to assess physical activity. Age, weeks gestation, height, weight, and history of knee problems prior to pregnancy were analyzed to identify independent associations with IKDC score and determine predictors of knee dysfunction. Results: 310 patients were included in this study, of which 68, 111 and 131 were in their first, second and trimesters, respectively. Mean age of the total study group was 30.3 ± 5.5 years. Knee function decreased with each trimester, from a mean IKDC score of 88.9 ± 13.0 in the first trimester, 84.5 ± 16.8 in the second, and 82.0 ± 20.0 in the third, with corresponding decreases in activity levels of 258.5 ± 141.7, 254.0 ± 141.5, and 246.1 ± 156.6 MET-h/wk. Of the total study group, 26.1% had IKDC scores <75, including 13.2%, 25.2%, and 33.6% in the first, second and third trimesters. Risk factors for knee dysfunction included high activity levels of PPAQ ≥ 500 MET-h/wk (OR 2.8), history of knee problems (OR 2.7), age <25 years (OR 2.6), and BMI ≥ 30 kg/m2 (OR 1.9). Conclusion: In our cohort, 26.1% of pregnant women reported severe knee dysfunction, and this was associated with high levels of activity, younger age, greater BMI, and history of knee problems. These findings may have implications for women who wish to maintain training and fitness during pregnancy. Future studies are recommended to assess the need for intervention, as well as to identify optimal methods to prevent and address symptoms in this population. Level of evidence: IV, Case Series.

Original languageEnglish (US)
Pages (from-to)78-83
Number of pages6
JournalPhysician and Sportsmedicine
Issue number1
StatePublished - 2022


  • Pregnancy
  • exercise
  • female athlete
  • knee pain
  • knee surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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