Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
National Institute of Technology, Tsuruoka College, Yamagata, Japan.
Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4162-4172. doi: 10.1007/s00167-022-07019-x. Epub 2022 Jun 3.
This study aims to (1) measure the kinematics of lower extremity alignment and the bony position relative to the ground during walking, focusing on the coronal plane, and (2) determine the correlation between the kinematics and coronal inclination of the medial tibial plateau (coronal inclination) for healthy and varus knee osteoarthritis (OA).
In this study, 43 women (non-OA, 9 knees; early OA, 13 knees; advanced OA, 21 knees; mean age 58 ± 17 years) were examined. The knee phenotypes in varus knee OA were varied. Three-dimensional (3D) knee kinematics were calculated in gait analysis by combining the motion capture system and the 3D lower extremity alignment assessment system via biplanar long-leg X-rays, applying the 3D-2D registration technique. The main parameters were the kinematics of the bony axes relative to the ground in the coronal plane during the stance phase of the gait. The differences in overall kinematics were assessed using repeated measures ANOVA with Tukey's post hoc test. The association between kinematic parameters and coronal inclination was evaluated by multiple linear regression after univariate analysis.
The tibia tilted laterally during the loading response, and a plateau area subsequently appeared until the terminal stance phase, whereas the femur slowly tilted laterally until the terminal stance phase. The dynamic alignment showed a relatively large varus angular change during the loading response in all groups. The trend of motion was similar among all groups (p = n.s.), although to varying degrees. The coronal inclination was the more dominant factor than the Kellgren-Lawrence (K-L) grades (β = - 0.423, p = 0.005) when the change in dynamic alignment was determined.
The TAA plateau area after the loading response implies that the tibial articular surface may become horizontal. The femur slowly tilted laterally until the terminal stance phase in response to the tibial motion. Consequently, the dynamic alignment showed a varus angular change, in which coronal MCT was more involved than K-L grades.
本研究旨在：(1) 测量下肢对线的运动学和在冠状面中相对于地面的骨骼位置，(2) 确定健康和内翻膝骨关节炎 (OA) 的冠状胫骨平台倾斜 (冠状倾斜) 的运动学与冠状面之间的相关性。
本研究纳入 43 名女性（非 OA，9 膝；早期 OA，13 膝；晚期 OA，21 膝；平均年龄 58±17 岁）。在侧方膝 OA 中，膝关节表型各不相同。通过运动捕捉系统和三维下肢对线评估系统，在步态分析中结合双侧长下肢 X 线，应用三维二维注册技术，计算膝关节运动学。主要参数是步态站立相期间冠状面中骨骼轴相对于地面的运动学。使用重复测量方差分析和 Tukey 事后检验评估整体运动学的差异。在单变量分析后，使用多元线性回归评估运动学参数与冠状倾斜的相关性。
胫骨在负重反应期间向外侧倾斜，随后出现平台区，直至终末期；而股骨则在终末期缓慢向外侧倾斜。所有组在负重反应期间动态对线显示出较大的内翻角变化。虽然程度不同，但所有组的运动趋势相似（p=无统计学意义）。在确定动态对线的变化时，冠状倾斜是比 Kellgren-Lawrence (K-L) 分级更重要的因素（β=-0.423，p=0.005）。
负重反应后的 TAA 平台区意味着胫骨关节面可能变平。胫骨运动导致股骨缓慢向外侧倾斜直至终末期。因此，动态对线显示出内翻角变化，其中冠状面 MCT 比 K-L 分级更涉及。
