An increased risk of developing knee disorders including radiographic knee osteoarthritis (OA) have been shown among workers with kneeling working demands. There may also be a dose-related association between duration of employment in occupations with kneeling work and development of radiographic knee OA and magnetic resonance imaging (MRI)-detected meniscal tears and bursitis.
A cross-sectional study of a historical cohort.
Members of the trade unions for floor layers and graphic designers in Denmark.
92 male floor layers and 49 graphic designers aged 36–70 years were randomly selected among participants from a clinical and radiographic study of 156 floor layers and 152 graphic designers.
Radiographic tibiofemoral (TF) and patellofemoral (PF) knee-OA and MRI-detected meniscal tears and bursitis. Results were adjusted for age, earlier knee traumas, sports activities and body mass index in logistic regression models. Association between TF OA and years in the floor-laying trade was graphically examined by a restricted cubic spline with four knots.
Increase in number of years with exposure to kneeling work is associated with radiographic TF knee OA with ORs 0.7, 95% CI 0.07 to 4.42; OR 1.89, 95% CI 0.29 to 12.3; OR 4.82, 95% CI 1.38 to 17 for <20 years, 20–30 years and >30 years of kneeling work, respectively. MRI-verified medial meniscal tears was increased among subjects with kneeling work with OR 1.96, 95% CI 0.79 to 4.88 to OR 4.73, 95% CI 1.16 to 19.4 but was not associated with duration of employment. Periarticular bursitis was increased in subjects with <20 years of kneeling working activity. Lateral meniscal tears and PF knee OA were not associated with duration of kneeling working activity or with kneeling work in general.
The findings suggest a dose–response relationship for radiographic TF knee OA in floor layers with a significant amount of kneeling work and an increase of MRI-verified medial meniscal tears among workers with kneeling work.
An increased risk of developing knee disorders including radiographic knee osteoarthritis (OA) have been shown among workers with kneeling working demands. Workers with kneeling working positions have an increased risk of developing knee complaints in a much higher degree than can be explained by osteoarthritis.
It is unknown if there is a dose-related association between duration of employment in occupations with kneeling work and development of radiographic knee OA including both tibiofemoral and patellofemoral knee OA.
It is unknown if MRI-detected meniscal tears and bursitis around the knees can explain some of the knee complaints in subjects with kneeling work.
The study shows a dose-response relationship between the duration of employment in work with kneeling working positions and tibiofemoral knee OA but not of patellofemoral knee OA.
There is an increased risk of developing MRI-detected medial meniscal tears and periarticular bursitis among floor layers compared with referents, but it is not associated to long duration of employment.
The study suggests that other knee disorders than osteoarthritis may explain that floor layers have knee complaints.
Strengths and limitations of the study
Study strength includes investigation with both radiographic and MRI, the description of a variety of knee disorders and the long duration of exposure among study group.
Limitation is the small number of participants due to economic reasons by conducting MRI.