Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Osteoarthritis Cartilage. 2016 Jul;24(7):1153-9. doi: 10.1016/j.joca.2016.01.987. Epub 2016 Feb 2.
Patients undergoing arthroscopic partial meniscectomy (APM) are at increased risk of knee osteoarthritis (OA). Meniscal damage and/or surgery may alter knee joint loading to increase OA risk. We investigated changes in knee joint loading following medial APM surgery, compared with the contra-lateral leg.
We estimated indices of knee joint loading (external peak knee adduction moment (KAM), KAM impulse and peak knee flexion moment (KFM)) normalized to body size (i.e., body mass (BM) and height (HT)) using 3D gait analysis in 23 patients (17 men, mean (SD) 46.2 (6.4) years, BMI 25.8 (3.4) kg/m(2)) without radiographic knee OA before and 12 months after medial APM. Static alignment was assessed by radiography and self-reported outcomes by Knee injury and Osteoarthritis Outcome Score (KOOS).
Peak KAM and KAM impulse increased in the APM leg compared to the contra-lateral leg from before to 12 months after surgery (change difference: 0.38 Nm/BMHT% 95% CI 0.01 to 0.76 (P = 0.049) and 0.20 Nms/BM*HT% 95% CI 0.10 to 0.30 (P < 0.001)). Patients self-reported improvements on all KOOS subscales (KOOS pain improvement: 22.8 95% CI 14.5 to 31.0 (P < 0.01)).
A relative increase in indices of medial compartment loading was observed in the leg undergoing APM compared with the contra-lateral leg from before to 12 months after surgery. This increase may contribute to the elevated risk of knee OA in these patients. Randomized trials including a non-surgical control group are needed to determine if changes in joint loading following APM are caused by surgery or by changes in symptoms.
接受关节镜下半月板部分切除术（APM）的患者患膝关节骨关节炎（OA）的风险增加。半月板损伤和/或手术可能改变膝关节负荷，增加 OA 风险。我们研究了内侧 APM 手术后膝关节负荷的变化，并与对侧腿进行了比较。
我们使用 3D 步态分析在 23 名患者（17 名男性，平均（标准差）46.2（6.4）岁，BMI 25.8（3.4）kg/m2）中估计了膝关节负荷指数（外部峰值膝关节内收力矩（KAM）、KAM 冲量和峰值膝关节屈曲力矩（KFM）），这些指数按身体大小（即体重（BM）和身高（HT））进行了归一化。在 APM 术前和术后 12 个月，通过放射摄影评估静态对线，通过膝关节损伤和骨关节炎结果评分（KOOS）评估自我报告结果。
与对侧腿相比，APM 腿的峰值 KAM 和 KAM 冲量在手术后从术前到 12 个月增加（变化差异：0.38 Nm/BMHT%95%置信区间 0.01 至 0.76（P=0.049）和 0.20 Nms/BM*HT%95%置信区间 0.10 至 0.30（P<0.001））。患者在所有 KOOS 子量表上自我报告改善（KOOS 疼痛改善：22.8 95%置信区间 14.5 至 31.0（P<0.01））。
与对侧腿相比，APM 术后腿的内侧间隙负荷指数相对增加。这种增加可能导致这些患者患膝关节 OA 的风险增加。需要包括非手术对照组的随机试验来确定 APM 后关节负荷的变化是由手术还是由症状变化引起的。
