Schrijvers Jim C, van den Noort Josien C, van der Esch Martin, Dekker Joost, Harlaar Jaap
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Musculoskeletal Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
Gait Posture. 2019 May;70:235-253. doi: 10.1016/j.gaitpost.2019.03.016. Epub 2019 Mar 20.
Instability of the knee joint during gait is frequently reported by patients with knee osteoarthritis or an anterior cruciate ligament rupture. The assessment of instability in clinical practice and clinical research studies mainly relies on self-reporting. Alternatively, parameters measured with gait analysis have been explored as suitable objective indicators of dynamic knee (in)stability.
This literature review aimed to establish an inventory of objective parameters of knee stability during gait.
Five electronic databases (Pubmed, Embase, Cochrane, Cinahl and SPORTDiscuss) were systematically searched, with keywords concerning knee, stability and gait. Eligible studies used an objective parameter(s) to assess knee (in)stability during gait, being stated in the introduction or methods section. Out of 10717 studies, 89 studies were considered eligible.
Fourteen different patient populations were investigated with kinematic, kinetic and/or electromyography measurements during (challenged) gait. Thirty-three possible objective parameters were identified for knee stability, of which the majority was based on kinematic (14 parameters) or electromyography (12 parameters) measurements. Thirty-nine studies used challenged gait (i.e. external perturbations, downhill walking) to provoke knee joint instability. Limited or conflicting results were reported on the validity of the 33 parameters.
In conclusion, a large number of different candidates for an objective knee stability gait parameter were found in literature, all without compelling evidence. A clear conceptual definition for dynamic knee joint stability is lacking, for which we suggest : "The capacity to respond to a challenge during gait within the natural boundaries of the knee". Furthermore biomechanical gait laboratory protocols should be harmonized, to enable future developments on clinically relevant measure(s) of knee stability during gait.
膝关节骨关节炎患者或前交叉韧带断裂患者在步态中常出现膝关节不稳定的情况。临床实践和临床研究中对膝关节不稳定的评估主要依赖于自我报告。另外，通过步态分析测量的参数已被探索作为动态膝关节（不）稳定的合适客观指标。
本综述旨在建立一份步态中膝关节稳定性客观参数的清单。
系统检索了五个电子数据库（PubMed、Embase、Cochrane、Cinahl和SPORTDiscuss），使用了与膝关节、稳定性和步态相关的关键词。符合条件的研究在引言或方法部分中使用了客观参数来评估步态中的膝关节（不）稳定性。在10717项研究中，有89项研究被认为符合条件。
在（挑战性）步态中，对14种不同的患者群体进行了运动学、动力学和/或肌电图测量。确定了33个可能的膝关节稳定性客观参数，其中大多数基于运动学（14个参数）或肌电图（12个参数）测量。39项研究使用挑战性步态（即外部扰动、下坡行走）来诱发膝关节不稳定。关于这33个参数的有效性，报告的结果有限或相互矛盾。
总之，文献中发现了大量不同的客观膝关节稳定性步态参数候选指标，但均缺乏确凿证据。目前缺乏动态膝关节稳定性的明确概念定义，我们建议定义为：“在步态中，膝关节在自然范围内应对挑战的能力”。此外，生物力学步态实验室方案应加以统一，以便未来在步态中膝关节稳定性的临床相关测量方面取得进展。
