Maly Monica R
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Curr Opin Rheumatol. 2008 Sep;20(5):547-52. doi: 10.1097/BOR.0b013e328307f58c.
This review examines recent advances in understanding the abnormal mechanics characteristic of knee osteoarthritis and provides a rationale to assess the total exposure to knee loading during daily activity.
The abnormal loading environment in knee osteoarthritis is represented by the knee adduction moment. While knee osteoarthritis gait research focuses on this variable, emerging evidence supports a critical role for knee kinematics, muscle activation patterns and the kinematics and kinetics of other lower extremity joints in the development and progression of this disease. Nevertheless, abnormal knee loading is not the only cause of articular cartilage disruption. Excessive and repetitive loading, together creating a total exposure to loading, are critical factors in knee pathomechanics. To assess excessive and repetitive loading, cumulative load is a biomechanical approach that integrates loading exposures to represent the accumulated load that knee tissues endure during physical activity.
Knee osteoarthritis pathomechanics involves an interaction between abnormal and excessive and/or repetitive loading. Mechanics of lower extremity joints and muscle activation patterns influence the knee loading environment. Future work could integrate measures of abnormal loading with assessments of the total exposure to loading during physical activity to better link biomechanics with clinical outcomes in knee osteoarthritis.
本综述探讨了在理解膝关节骨关节炎异常力学特征方面的最新进展，并为评估日常活动期间膝关节负荷的总暴露量提供了理论依据。
膝关节骨关节炎的异常负荷环境以膝关节内收力矩为代表。虽然膝关节骨关节炎步态研究聚焦于这一变量，但新出现的证据支持膝关节运动学、肌肉激活模式以及其他下肢关节的运动学和动力学在该疾病发生发展过程中起关键作用。然而，膝关节异常负荷并非关节软骨破坏的唯一原因。过度和重复性负荷共同构成了负荷的总暴露量，是膝关节病理力学中的关键因素。为了评估过度和重复性负荷，累积负荷是一种生物力学方法，它整合负荷暴露量以表示膝关节组织在体力活动期间承受的累积负荷。
膝关节骨关节炎病理力学涉及异常负荷与过度和/或重复性负荷之间的相互作用。下肢关节力学和肌肉激活模式会影响膝关节负荷环境。未来的研究可以将异常负荷的测量与体力活动期间负荷总暴露量的评估相结合，以便更好地将生物力学与膝关节骨关节炎的临床结果联系起来。
