Erhart-Hledik Jennifer C, Mahtani Gordhan B, Asay Jessica L, Migliore Eleonora, Nguyen Michelle M, Andriacchi Thomas P, Chu Constance R
Department of Orthopaedic Surgery, Stanford University, Stanford, California.
VA Palo Alto Health Care System, Palo Alto, California.
J Orthop Res. 2021 Mar;39(3):619-627. doi: 10.1002/jor.24770. Epub 2020 Jun 22.
This study aimed to determine if changes in knee adduction moment (KAM) after 6 months of variable-stiffness shoe wear are associated with changes in symptoms or serum levels of cartilage oligomeric matrix protein (COMP) following a mechanical stimulus in subjects with medial knee osteoarthritis (OA). Twenty-five subjects were enrolled in the study and assigned a variable-stiffness shoe, and 19 subjects completed the 6-month follow-up. At baseline and follow-up subjects underwent gait analysis in control and variable-stiffness shoes, completed Western Ontario and McMaster Universities (WOMAC) questionnaires, and serum COMP concentrations were measured immediately before, 3.5 and 5.5 hours after a 30-minute walking activity. Relationships between changes in KAM (first peak and impulse) and changes in (a) COMP levels in response to the 30-minute walking activity and (b) WOMAC scores from baseline to 6-month follow-up were assessed by Pearson correlation coefficients. Changes in first peak KAM were associated with changes in COMP levels 5.5 hours postactivity from baseline to follow-up (R = .564, P = .045). Subjects with greater reductions in KAM had larger decreases in COMP (expressed as a percent of preactivity levels) at follow-up. Subjects with greater reductions in KAM impulse had significantly greater improvements in WOMAC Pain (R = -.56, P = .015) and Function (R = -.52, P = .028) scores at follow-up. The study results demonstrated the magnitude of reduction in the KAM wearing a variable-stiffness shoe is associated with decreases in mechanically stimulated COMP levels and pain/function. This work suggests that interactions between COMP and joint loading during walking should be further investigated in future studies of treatment outcomes in OA.
本研究旨在确定在患有膝内侧骨关节炎（OA）的受试者中，穿着可变刚度鞋6个月后膝关节内收力矩（KAM）的变化是否与机械刺激后症状的变化或软骨寡聚基质蛋白（COMP）的血清水平变化相关。25名受试者参与了本研究，并被分配穿着可变刚度鞋，19名受试者完成了6个月的随访。在基线和随访时，受试者穿着对照鞋和可变刚度鞋进行步态分析，完成西安大略和麦克马斯特大学（WOMAC）问卷，并在30分钟步行活动前、活动后3.5小时和5.5小时立即测量血清COMP浓度。通过Pearson相关系数评估KAM（第一个峰值和冲量）的变化与（a）30分钟步行活动后COMP水平的变化以及（b）从基线到6个月随访的WOMAC评分变化之间的关系。从基线到随访，第一个峰值KAM的变化与活动后5.5小时COMP水平的变化相关（R = 0.564，P = 0.045）。在随访时，KAM降低幅度更大的受试者COMP降低幅度更大（以活动前水平的百分比表示）。KAM冲量降低幅度更大的受试者在随访时WOMAC疼痛（R = -0.56，P = 0.015）和功能（R = -0.52，P = 0.028）评分有显著更大的改善。研究结果表明，穿着可变刚度鞋时KAM降低的幅度与机械刺激后COMP水平的降低以及疼痛/功能的改善相关。这项工作表明，在未来关于OA治疗结果的研究中，应进一步研究COMP与步行过程中关节负荷之间的相互作用。
