Hall M, Bennell K L, Wrigley T V, Metcalf B R, Campbell P K, Kasza J, Paterson K L, Hunter D J, Hinman R S
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, VIC, Australia.
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, VIC, Australia.
Osteoarthritis Cartilage. 2017 Jan;25(1):34-41. doi: 10.1016/j.joca.2016.08.014. Epub 2016 Sep 9.
To investigate relationships between external knee adduction moment parameters (KAM) and osteoarthritis (OA) symptoms according to disease severity.
164 participants with symptomatic medial knee OA were included. Radiographic severity was graded by (1) Kellgren & Lawrence (KL) scale (Grade 2, n = 49; Grade, n = 52; Grade 4, n = 63) and; (2) medial tibiofemoral joint space narrowing (JSN) (Grade 1, n = 47; Grade 2, n = 50; Grade 3, n = 67). KAM-related parameters (peak KAM, KAM impulse and cumulative load) were determined from three-dimensional gait analysis and pedometry. Cumulative load was determined by multiplying KAM impulse by the average number of steps/day recorded over at least 5 days. Symptoms were assessed via numeric rating scale ((NRS), pain) and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (pain and physical function). Relationships between KAM parameters (independent variables) and symptoms (dependent variables) were evaluated by radiographic severity using linear models, adjusting for covariates.
In mild disease (either KL Grade 2 or JSN Grade 1), there were no associations between KAM and symptoms. In moderate disease of KL Grade 3, higher KAM impulse was associated with greater WOMAC pain. In severe disease (KL Grade 4), higher KAM impulse was associated with less WOMAC pain (KL Grade 4), while higher peak KAM was associated with better function (KL Grade 4). Higher cumulative knee adduction load was associated with less pain on both NRS and WOMAC (JSN Grade 3) as well as better function (both JSN Grade 3 and KL Grade 4).
Relationships between KAM-related parameters and symptoms differ according to underlying radiographic OA severity.
根据疾病严重程度，研究膝关节内收力矩参数（KAM）与骨关节炎（OA）症状之间的关系。
纳入164例有症状的膝关节内侧OA患者。通过以下两种方法对影像学严重程度进行分级：（1）Kellgren&Lawrence（KL）分级（2级，n = 49；3级，n = 52；4级，n = 63）；（2）内侧胫股关节间隙变窄（JSN）分级（1级，n = 47；2级，n = 50；3级，n = 67）。通过三维步态分析和计步器确定与KAM相关的参数（KAM峰值、KAM冲量和累积负荷）。累积负荷通过KAM冲量乘以至少5天记录的每日平均步数来确定。通过数字评分量表（NRS，疼痛）和西安大略和麦克马斯特大学（WOMAC）骨关节炎指数（疼痛和身体功能）评估症状。使用线性模型，根据影像学严重程度评估KAM参数（自变量）与症状（因变量）之间的关系，并对协变量进行校正。
在轻度疾病（KL 2级或JSN 1级）中，KAM与症状之间无关联。在KL 3级的中度疾病中，较高的KAM冲量与更严重的WOMAC疼痛相关。在重度疾病（KL 4级）中，较高的KAM冲量与较轻的WOMAC疼痛相关（KL 4级），而较高的KAM峰值与更好的功能相关（KL 4级）。较高的膝关节内收累积负荷与NRS和WOMAC上较轻的疼痛相关（JSN 3级）以及更好的功能相关（JSN 3级和KL 4级）。
根据潜在的影像学OA严重程度，与KAM相关的参数和症状之间的关系有所不同。
