Thoma L M, McNally M P, Chaudhari A M, Best T M, Flanigan D C, Siston R A, Schmitt L C
Department of Physical Therapy, University of Delaware, Newark, DE, USA.
School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.
Osteoarthritis Cartilage. 2017 Jul;25(7):1046-1054. doi: 10.1016/j.joca.2017.02.794. Epub 2017 Feb 20.
To determine compartment-specific loading patterns during gait, quantified as joint reaction forces (JRF), of individuals with knee articular cartilage defects (ACD) compared to healthy controls (HC).
Individuals with ACDs and HC participated. Individuals with ACDs were divided into groups according to ACD location: PF (only a patellofemoral ACD), TF (only a tibiofemoral ACD), and MIX (both PF and TF ACDs). Participants underwent three-dimensional gait analysis at self-selected speed. TF joint reaction force (TF-JRF) was calculated using inverse dynamics. PF joint reaction force (PF-JRF) was derived from estimated quadriceps force (F) and knee flexion angle. Primary variables of interest were the PF- and TF-JRF peaks (body weight [×BW]). Related secondary variables (gait speed, quadriceps strength, knee function, activity level) were evaluated as covariates.
First peak PF-JRF and TF-JRF were similar in the TF and MIX groups (0.75-1.0 ×BW, P = 0.6-0.9). Both peaks were also similar in the PF and HC groups (1.1-1.3 ×BW, P = 0.7-0.8), and higher than the TF and MIX groups (P = 0.004-0.02). For the second peak PF-JRF, only the HC group was higher than the TF group (P = 0.02). The PF group walked at a similar speed as the HC group; both groups walked faster than the TF and MIX groups (P < 0.001). With gait speed and quadriceps strength as covariates, no differences were observed in JRF peaks.
The results suggest the presence of a TF ACD (TF and MIX groups), but not a PF ACD (PF group), may affect joint loading patterns during walking. Walking slower may be a protective gait modification to reduce load.
确定膝关节软骨缺损（ACD）个体与健康对照（HC）相比，在步态期间特定腔室的负荷模式，以关节反应力（JRF）进行量化。
招募了患有ACD的个体和HC。患有ACD的个体根据ACD位置分为几组：PF组（仅髌股关节ACD）、TF组（仅胫股关节ACD）和MIX组（髌股关节和胫股关节均有ACD）。参与者以自选速度进行三维步态分析。使用逆动力学计算胫股关节反应力（TF-JRF）。髌股关节反应力（PF-JRF）由估计的股四头肌力量（F）和膝关节屈曲角度得出。主要关注变量为PF-JRF和TF-JRF峰值（体重[×BW]）。相关次要变量（步态速度、股四头肌力量、膝关节功能、活动水平）作为协变量进行评估。
TF组和MIX组的首个PF-JRF和TF-JRF峰值相似（0.75 - 1.0×BW，P = 0.6 - 0.9）。PF组和HC组的这两个峰值也相似（1.1 - 1.3×BW，P = 0.7 - 0.8），且高于TF组和MIX组（P = 0.004 - 0.02）。对于第二个PF-JRF峰值，仅HC组高于TF组（P = 0.02）。PF组的步行速度与HC组相似；两组的步行速度均快于TF组和MIX组（P < 0.001）。以步态速度和股四头肌力量作为协变量时，JRF峰值未观察到差异。
结果表明存在胫股关节ACD（TF组和MIX组）而非髌股关节ACD（PF组）可能会影响步行期间的关节负荷模式。较慢的步行速度可能是一种减轻负荷的保护性步态改变。
