Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
Gait Posture. 2021 Feb;84:127-136. doi: 10.1016/j.gaitpost.2020.10.033. Epub 2020 Nov 5.
Attempts to improve protocol standards of marker-based clinical gait analysis (CGA) have been one of the main focuses of research to enhance robustness and reliability outcomes since the 1990s. Determining joint centres and axes constitutes an important aspect of those protocols. Although the hip joint is more prominent in such studies, knee joint center (KJC) and axis (KJA) directly affect all outcomes.
What recommendations arise from the study of the scientific literature for determining knee joint parameters (KJP) for protocols of CGA?
A systematic, electronic search was conducted on November 2018 using three databases with the keyword combination ("functional approach" OR "functional method" OR "functional calibration") AND ("hip joint" OR "knee joint" OR "ankle joint") and analyzed by four reviewers. Given the existence of a recent review about the hip joint and the lack of material about the ankle joint, only papers about the knee joint were kept. The references cited in the selected papers were also screened in the final round of the search for these publications. The quality of the selected papers was assessed and aspects regarding accuracy, repeatability, and feasibility were thoroughly considered to allow for a comparison between studies. Technical aspects, such as marker set choice, KJP determination techniques, demographics, and functional movements, were also included.
Thirty-one papers were included and on average received a rating of about 75 % according to the quality scale used. The results showed that functional methods are superior or equivalent to predictive methods to estimate the KJA, while a regression method was slightly better for KJC prediction.
Calibration methods should be applied to CGA whenever feasibility is reached. No study to date has focused on evaluating the in vivo RoM required to obtain reliable and repeatable results and future work should aim in this direction.
自 20 世纪 90 年代以来，提高基于标志物的临床步态分析（CGA）协议标准一直是研究的主要焦点之一，以增强稳健性和可靠性结果。确定关节中心和轴是这些协议的一个重要方面。虽然髋关节在这些研究中更为突出，但膝关节中心（KJC）和轴（KJA）直接影响所有结果。
从科学文献研究中，对于 CGA 协议中膝关节参数（KJP）的确定，有哪些建议？
2018 年 11 月，我们使用三个数据库，以关键词组合（“功能方法”或“功能方法”或“功能校准”）和（“髋关节”或“膝关节”或“踝关节”）进行了系统的电子搜索，并由四名评审员进行了分析。鉴于最近有一篇关于髋关节的综述，而且关于踝关节的材料很少，因此只保留了关于膝关节的论文。在搜索的最后一轮中，还筛选了选定论文中引用的参考文献，以寻找这些出版物。评估了选定论文的质量，并深入考虑了准确性、可重复性和可行性等方面，以允许对研究进行比较。还包括技术方面，如标记集选择、KJP 确定技术、人口统计学和功能运动。
共纳入 31 篇论文，根据使用的质量评分标准，平均评分约为 75%。结果表明，功能方法优于或等同于预测方法来估计 KJA，而回归方法在预测 KJC 方面稍好一些。
只要达到可行性，就应将校准方法应用于 CGA。迄今为止，尚无研究专门评估获得可靠和可重复结果所需的体内 RoM，未来的工作应朝这个方向努力。
