Clément Julien, Toliopoulos Panagiota, Hagemeister Nicola, Desmeules François, Fuentes Alexandre, Vendittoli Pascal-André
Hôpital Maisonneuve-Rosemont, Université de Montréal 5415 Boulevard de l'Assomption Montreal, Quebec, H1T 2M4, Canada; Laboratoire de recherche en imagerie orthopédique, École de technologie supérieure, Centre de recherche du CHUM, Tour Viger 900, rue St-Denis, local R11.322 Montreal, Quebec, H2X 0A9, Canada.
Hôpital Maisonneuve-Rosemont, Université de Montréal 5415 Boulevard de l'Assomption Montreal, Quebec, H1T 2M4, Canada.
Gait Posture. 2018 Jul;64:198-204. doi: 10.1016/j.gaitpost.2018.06.024. Epub 2018 Jun 11.
Normal 3D knee kinematics during gait is still not well understood, especially regarding differences between women and men.
The objective of the present study was to characterize 3D knee kinematics during gait in healthy women and men with a validated tool.
Knee kinematics was analysed with the KneeKG™ system in 90 healthy subjects (49 females and 41 males). 3D knee rotations were compared between women and men, and between right and left knees. Each subject underwent full-length weight-bearing x-rays. Correlations between abduction-adduction angles and lower-limb alignment measures on x-rays were assessed.
In the frontal plane, 2.0-5.0° more abduction occurred in women compared to men (0.000 ≤ p ≤ 0.015) throughout the entire gait cycle. In the transverse plane, 2.4-3.7° more external tibial rotation was seen in women than in men (0.002 ≤ p ≤ 0.041) during the initial and mid-swing phases. No difference was found between the right and left knees. Low correlations (-0.52 ≤ r≤-0.41, p < 0.001) were observed between radiographic hip-knee-ankle angle (HKA) and abduction-adduction angles throughout the stance phase.
Kinematic differences between women and men in the frontal plane can be partly explained by their anatomical differences: women were less in varus than men (HKA of -0.8° vs. -2.6°, p < 0.001). Our study contributes to a better understanding of healthy 3D knee kinematics during gait and highlights the need for accounting of gender differences in future investigations. Better knowledge of natural knee kinematics will be helpful in assessing pathological gait patterns or determining the efficiency of conservative and surgical treatments to restore normal kinematics.
步态期间正常的三维膝关节运动学仍未得到很好的理解，尤其是关于女性和男性之间的差异。
本研究的目的是使用经过验证的工具来描述健康女性和男性在步态期间的三维膝关节运动学特征。
使用KneeKG™系统对90名健康受试者（49名女性和41名男性）的膝关节运动学进行分析。比较了女性和男性之间以及左右膝关节之间的三维膝关节旋转情况。每位受试者都进行了全长负重X线检查。评估了外展-内收角度与X线片上下肢对线测量值之间的相关性。
在额状面，在整个步态周期中，女性比男性多出现2.0-5.0°的外展（0.000≤p≤0.015）。在横断面，在初始摆动期和摆动中期，女性比男性多出现2.4-3.7°的胫骨外旋（0.002≤p≤0.041）。左右膝关节之间未发现差异。在整个站立期，影像学上的髋-膝-踝角（HKA）与外展-内收角度之间观察到低相关性（-0.52≤r≤-0.41，p<0.001）。
女性和男性在额状面的运动学差异部分可由其解剖学差异解释：女性的内翻程度低于男性（HKA为-0.8°对-2.6°，p<0.001）。我们的研究有助于更好地理解步态期间健康的三维膝关节运动学，并强调在未来研究中考虑性别差异的必要性。更好地了解自然膝关节运动学将有助于评估病理性步态模式或确定保守治疗和手术治疗恢复正常运动学的效率。
