Iijima Hirotaka, Fukutani Naoto, Yamamoto Yuko, Hiraoka Masakazu, Miyanobu Kazuyuki, Jinnouchi Masashi, Kaneda Eishi, Isho Takuya, Aoyama Tomoki, Kuroki Hiroshi, Matsuda Shuichi
Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Department of System Design Engineering, Keio University, Yokohama, Japan.
Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Gait Posture. 2017 Oct;58:394-400. doi: 10.1016/j.gaitpost.2017.08.033. Epub 2017 Aug 31.
This cross-sectional study investigated (i) the association of varus thrust during gait with the presence of patellofemoral osteoarthritis (PFOA) in patients with medial knee osteoarthritis (OA) and (ii) patellar alignment in the knees with varus thrust. Participants from orthopedic clinics (n=171; mean age, 73.4 years; 71.9% female) diagnosed with radiographic medial knee OA (Kellgren/Lawrence [K/L] grade ≥1) were included in this study, and underwent gait observation for varus thrust assessment using 2D video analysis. A radiographic skyline view was used to assess the presence of medial PFOA using the grading system from the Osteoarthritis Research Society International Atlas. The tibiofemoral joint K/L grade, patellar alignment (i.e., lateral shift and tilting angle), and knee pain intensity were also evaluated as covariates. Thirty-two (18.7%) of 171 patients exhibited varus thrust and they presented significantly higher knee pain (46.0±3.04mm vs. 32.4±2.73mm; P=0.024), a lower patellar tilting angle (P=0.024), and a higher prevalence of PFOA compared with those without varus thrust. A logistic regression analysis with adjustment of covariates showed that varus thrust was significantly associated with higher odds of the presence of mixed and medial PFOA, and trended to significantly associate with any PFOA, including lateral PFOA. This indicates that varus thrust was associated with PFOA in a compartment-nonspecific manner in patients with medial knee OA. Varus thrust may represent a clinical disease feature of more advanced and multicompartmental disease.
（i）膝关节内侧骨关节炎（OA）患者步态中内翻推力与髌股骨关节炎（PFOA）存在之间的关联；以及（ii）存在内翻推力的膝关节中的髌骨排列情况。本研究纳入了来自骨科诊所的参与者（n = 171；平均年龄73.4岁；71.9%为女性），这些参与者经影像学诊断为膝关节内侧OA（Kellgren/Lawrence [K/L]分级≥1），并使用二维视频分析对其进行步态观察以评估内翻推力。采用国际骨关节炎研究学会图谱的分级系统，通过放射影像学天际线视图评估内侧PFOA的存在情况。还评估了胫股关节K/L分级、髌骨排列（即外侧移位和倾斜角度）以及膝关节疼痛强度作为协变量。171例患者中有32例（18.7%）表现出内翻推力，与无内翻推力的患者相比，他们的膝关节疼痛明显更严重（46.0±3.04mm对32.4±2.73mm；P = 0.024），髌骨倾斜角度更低（P = 0.024），且PFOA的患病率更高。经协变量调整的逻辑回归分析表明，内翻推力与混合性和内侧PFOA存在的较高几率显著相关，并且倾向于与包括外侧PFOA在内的任何PFOA显著相关。这表明在膝关节内侧OA患者中，内翻推力与PFOA以关节间非特异性方式相关。内翻推力可能代表更晚期和多关节疾病的一种临床疾病特征。
