Yoon Jung-Ro, Joo Hong Joon, Lee Seung Hoon
Department of Orthopedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, 05368, Republic of Korea.
Knee Surg Relat Res. 2022 Feb 19;34(1):6. doi: 10.1186/s43019-022-00134-6.
The quadriceps muscle has a positive effect on anterior knee pain. However, its effect on the patellofemoral (PF) cartilage in patients with end-stage knee osteoarthritis is unknown. The present study aimed to evaluate whether the quadriceps muscle area had a positive effect on the PF cartilage and whether this muscle had a positive effect on the clinical scores.
Patients with confirmed cartilage status and clinical scores who underwent total knee arthroplasty (TKA) were included. The PF cartilage status was evaluated during TKA. The thickness and the area of the quadriceps muscle were measured using a knee computed tomography scan obtained before the surgery. The Q-angle, hip-knee-ankle angle, alignment, and Insall-Salvati ratio were measured by radiography.
Altogether, 204 patients were included in the study. Logistic regression was performed including factors associated with PF cartilage lesions. The regression model was found to be statistically significant (Hosmer-Lemeshow test, χ = 0.493). A smaller hip-knee-ankle (HKA) angle was associated with a higher incidence of PF cartilage lesions (p = 0.033) and only the alignment had an effect on the PF cartilage lesions. PF cartilage lesions did not correlate with the clinical scores. A thicker medial portion of the quadriceps muscle was associated with a significantly higher Knee Society Knee Score (KSKS) (p = 0.028).
Quadriceps muscle thickness and area, Q-angle, and patellar height were not associated with PF cartilage lesions, while a smaller HKA angle was associated with PF cartilage lesions. The presence of PF cartilage lesions did not affect the clinical symptoms. However, a thicker medial portion of the quadriceps muscle was associated with a higher KSKS.
股四头肌对膝关节前侧疼痛有积极作用。然而，其对终末期膝关节骨关节炎患者髌股（PF）软骨的影响尚不清楚。本研究旨在评估股四头肌面积是否对PF软骨有积极作用，以及该肌肉是否对临床评分有积极作用。
纳入接受全膝关节置换术（TKA）且软骨状态和临床评分已确诊的患者。在TKA过程中评估PF软骨状态。术前通过膝关节计算机断层扫描测量股四头肌的厚度和面积。通过X线摄影测量Q角、髋-膝-踝角、对线情况和Insall-Salvati比率。
本研究共纳入204例患者。进行了逻辑回归分析，纳入了与PF软骨损伤相关的因素。回归模型具有统计学意义（Hosmer-Lemeshow检验，χ = 0.493）。较小的髋-膝-踝（HKA）角与PF软骨损伤的发生率较高相关（p = 0.033），且只有对线情况对PF软骨损伤有影响。PF软骨损伤与临床评分无关。股四头肌内侧部分较厚与膝关节协会膝关节评分（KSKS）显著更高相关（p = 0.028）。
股四头肌厚度和面积、Q角和髌骨高度与PF软骨损伤无关，而较小的HKA角与PF软骨损伤相关。PF软骨损伤的存在不影响临床症状。然而，股四头肌内侧部分较厚与较高的KSKS相关。
