Kean Crystal O, Hinman Rana S, Bowles Kelly Ann, Cicuttini Flavia, Davies-Tuck Miranda, Bennell Kim L
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia.
Clin Biomech (Bristol). 2012 Jun;27(5):520-3. doi: 10.1016/j.clinbiomech.2011.12.007. Epub 2012 Jan 12.
The peak knee adduction moment is a valid proxy for medial knee joint loading. However as it only measures load at one instance of stance, knee adduction moment impulse, a measure that takes into account both the magnitude and duration of the stance phase, may provide more comprehensive information. This study directly compared the abilities of peak knee adduction moment and knee adduction moment impulse to distinguish between knee osteoarthritis severities.
169 participants with medial knee osteoarthritis completed radiographic and magnetic resonance imaging, the Western Ontario and McMaster Universities Arthritis Index to assess pain and a three-dimensional gait analysis. Participants were classified using four dichotomous classifications: Kellgren-Lawrence grading, alignment, medial tibiofemoral bone marrow lesions, and pain.
When using Kellgren-Lawrence grade and alignment classifications, the area under the receiver operator curves were significantly greater for knee adduction moment impulse than for peak knee adduction moment. Based on analysis of covariance, knee adduction moment impulse was significantly different between Kellgren-Lawrence grade and alignment groups while peak knee adduction moment was not significantly different. Both peak knee adduction moment and knee adduction moment impulse distinguished between bone marrow lesion severities while neither measure was significantly different between pain severity groups.
Findings suggest knee adduction moment impulse is more sensitive at distinguishing between disease severities and may provide more comprehensive information on medial knee joint loading. Future studies investigating biomechanics of knee osteoarthritis should include knee adduction moment impulse in conjunction with peak knee adduction moment.
膝关节内收力矩峰值是膝关节内侧负荷的有效替代指标。然而，由于它仅测量站立期某一时刻的负荷，膝关节内收力矩冲量（一种同时考虑站立期大小和持续时间的指标）可能会提供更全面的信息。本研究直接比较了膝关节内收力矩峰值和膝关节内收力矩冲量区分膝关节骨关节炎严重程度的能力。
169名患有膝关节内侧骨关节炎的参与者完成了X线摄影和磁共振成像、西安大略和麦克马斯特大学骨关节炎指数以评估疼痛情况以及三维步态分析。参与者使用四种二分法分类：凯尔格伦-劳伦斯分级、对线情况、胫股内侧骨髓损伤和疼痛情况。
在使用凯尔格伦-劳伦斯分级和对线情况分类时，膝关节内收力矩冲量的受试者工作特征曲线下面积显著大于膝关节内收力矩峰值。基于协方差分析，凯尔格伦-劳伦斯分级组和对线情况组之间膝关节内收力矩冲量存在显著差异，而膝关节内收力矩峰值无显著差异。膝关节内收力矩峰值和膝关节内收力矩冲量均能区分骨髓损伤的严重程度，而在疼痛严重程度组之间两种测量方法均无显著差异。
研究结果表明，膝关节内收力矩冲量在区分疾病严重程度方面更敏感，并且可能提供关于膝关节内侧负荷的更全面信息。未来研究膝关节骨关节炎生物力学时应同时纳入膝关节内收力矩冲量和膝关节内收力矩峰值。
