Creaby Mark W, Hunt Michael A, Hinman Rana S, Bennell Kim L
School of Exercise Science, Australian Catholic University, Queensland, Australia; Centre for Health, Exercise & Sports Medicine, University of Melbourne, Victoria, Australia.
Clin Biomech (Bristol). 2013 Oct;28(8):916-20. doi: 10.1016/j.clinbiomech.2013.07.013. Epub 2013 Jul 26.
High mechanical loading has been consistently linked with medial tibiofemoral osteoarthritis, and is considered to play a central role in the pathogenesis of the disease. Evidence from healthy adults indicates that knee flexion kinematics may influence knee load. The purpose of this study therefore, was to investigate the association between knee flexion kinematics and indicators of joint loading during walking (peak moments and vertical ground reaction force), in individuals with medial tibiofemoral osteoarthritis.
In this cross-sectional study, 89 participants with painful medial tibiofemoral osteoarthritis completed three-dimensional walking gait analysis to measure stance phase ground reaction forces, knee joint moments, and knee flexion kinematics.
In stepwise regression, greater knee flexion excursion was associated with higher peak vertical ground reaction force, accounting for 10% of its variance (B=0.62 [95% CI 0.34, 0.89], P<0.001). Greater peak knee flexion was associated with a higher flexion moment, accounting for 44% of its variance (B=0.12 [95% CI 0.09, 0.15], P<0.001). No association was found between the knee adduction moment and knee flexion kinematics during walking.
Our data suggest that greater knee flexion is associated with higher joint loads in the sagittal plane (i.e. a higher peak knee flexion moment). However, knee flexion kinematics were not associated with the knee adduction moment - a proxy measure of medial compartment knee load. Thus, high knee flexion should be considered an undesirable gait characteristic with respect to knee load in individuals with medial tibiofemoral osteoarthritis.
高机械负荷一直与胫股内侧骨关节炎相关联，并被认为在该疾病的发病机制中起核心作用。来自健康成年人的证据表明，膝关节屈曲运动学可能会影响膝关节负荷。因此，本研究的目的是调查胫股内侧骨关节炎患者膝关节屈曲运动学与步行过程中关节负荷指标（峰值力矩和垂直地面反作用力）之间的关联。
在这项横断面研究中，89名患有疼痛性胫股内侧骨关节炎的参与者完成了三维步行步态分析，以测量站立期地面反作用力、膝关节力矩和膝关节屈曲运动学。
在逐步回归分析中，更大的膝关节屈曲幅度与更高的垂直地面反作用力峰值相关，占其方差的10%（B = 0.62 [95% CI 0.34, 0.89]，P < 0.001）。更大的膝关节屈曲峰值与更高的屈曲力矩相关，占其方差的44%（B = 0.12 [95% CI 0.09, 0.15]，P < 0.001）。步行过程中未发现膝关节内收力矩与膝关节屈曲运动学之间存在关联。
我们的数据表明，更大的膝关节屈曲与矢状面更高的关节负荷相关（即更高的膝关节屈曲峰值力矩）。然而，膝关节屈曲运动学与膝关节内收力矩（胫股内侧关节负荷的替代指标）无关。因此，对于胫股内侧骨关节炎患者，就膝关节负荷而言，高膝关节屈曲应被视为一种不良的步态特征。
