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膝关节骨关节炎中前侧畸形程度的增加与踝关节韧带不稳定无关。

Increasing grades of frontal deformities in knee osteoarthritis are not associated with ligamentous ankle instabilities.

机构信息

Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.

Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1704-1713. doi: 10.1007/s00167-022-07021-3. Epub 2022 Jun 6.

Abstract

PURPOSE

Varus or valgus deformities in knee osteoarthritis may have a crucial impact on ankle subtalar range of motion (ROM) and ligamentous stability. The purpose of this study was to assess whether the grade of ankle eversion and inversion rotation stability was influenced by frontal deformities of the knee joint.

METHODS

Patients who were planned to undergo total knee arthroplasty (TKA) were prospectively included in this study. Patients were examined radiologically (mechanical tibiofemoral angle (mTFA), hindfoot alignment view angle (HAVA), anterior distal tibia angle (ADTA)) and clinically (ROM of the knee and ankle joint, foot function index, knee osteoarthritis outcome score). Ankle stability was assessed using an ankle arthrometer (AA) to test inversion/eversion (ie) rotation and anterior/posterior (ap) displacement stability of the ankle joint. Correlations were calculated using Pearson's coefficient, and differences between two independent groups of nonparametric data were calculated using a two-sided Wilcoxon signed rank test.

RESULTS

Eighty-two (varus n = 52, valgus n = 30) patients were included. The preoperative mTFA significantly correlated with the HAVA (Pearson's correlation = - 0.72, p < 0.001). Laxity testing of the ankle demonstrated that in both varus and valgus knee osteoarthritis, higher grades of mTFA did not correlate with the inversion or eversion capacity of the ankle joint. The ADTA significantly correlated with the posterior displacement of the ankle joint (cor = 0.24, p = 0.049).

CONCLUSIONS

This study could not confirm that higher degrees of frontal knee deformities in osteoarthritis were associated with increasing grades of ligamentous ankle instabilities or a reduced ROM of the subtalar joint.

LEVEL OF EVIDENCE

II.

摘要

目的

膝关节骨关节炎的内翻或外翻畸形可能对踝关节距下关节活动范围(ROM)和韧带稳定性有至关重要的影响。本研究的目的是评估膝关节前向畸形是否会影响踝关节外翻和内翻旋转稳定性的程度。

方法

本前瞻性研究纳入了计划行全膝关节置换术(TKA)的患者。患者接受了影像学(机械胫股角(mTFA)、后足对线角(HAVA)、前远端胫骨角(ADTA))和临床检查(膝关节和踝关节 ROM、足功能指数、膝关节骨关节炎结局评分)。使用踝关节关节测动仪(AA)评估踝关节稳定性,以测试踝关节的内翻/外翻(即)旋转和前/后(ap)位移稳定性。使用 Pearson 相关系数计算相关性,使用双侧 Wilcoxon 符号秩检验计算两组非参数数据之间的差异。

结果

共纳入 82 例患者(内翻组 n=52,外翻组 n=30)。术前 mTFA 与 HAVA 显著相关(Pearson 相关系数=-0.72,p<0.001)。踝关节松弛度测试表明,在膝关节内翻和外翻骨关节炎中,较高的 mTFA 分级与踝关节的内翻或外翻能力均无相关性。ADTA 与踝关节的后向位移显著相关(相关系数=0.24,p=0.049)。

结论

本研究不能证实膝关节骨关节炎的前向畸形程度与踝关节韧带不稳定程度增加或距下关节 ROM 降低相关。

证据等级

II 级。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fa0/10090006/8e3ae2c1fe2b/167_2022_7021_Fig1_HTML.jpg

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