Department of Orthopedics & Traumatology, Shuguang Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Pudong New Area, Shanghai, China.
University of Salford, School of Health Sciences, Manchester, M6 6PU, UK.
Sci Rep. 2024 Sep 17;14(1):21692. doi: 10.1038/s41598-024-72934-7.
Quantitative three-dimensional gait analysis has been used to evaluate the loading at the knee (i.e. external knee adduction moment, EKAM) during level ground walking in individuals with knee osteoarthritis (OA). The magnitude of EKAM can be influenced by some factors, such as knee marker position and foot placement angles in static calibration trials, which may lead to inaccurate functional assessments and intervention planning. This study aimed to clarify the effects of knee position during static calibration trials on the evaluation of knee loading during gait in individuals with medial knee OA. Seventeen individuals with medial knee OA completed three different static standing trials; (1) knee flexed at 0 degrees, (2) knee flexed at 15 degrees, and (3) knee flexed at 30 degrees before walking at their self-selected speed. A sixteen-camera three-dimensional VICON gait analysis system with four AMTI force platforms was used to collect the EKAM, knee adduction angular impulse (KAAI), knee joint center (KJC), and other knee kinematic and kinetic variables during gait. A repeated measures ANOVA was used to investigate the differences between conditions. The 1st peak of EKAM, the 1st peak EKAM arm, KAAI, and knee extension moment were significantly increased at the 15-degree and 30-degree conditions in comparison with the 0-degree condition (P < 0.05). Additionally, the knee flexion moment and knee external rotation moment were significantly reduced at the 15-degree and 30-degree conditions in comparison with the 0-degree condition (P < 0.05). All biomechanical variables were influenced by the localization of the KJC during static calibration trials. The changes in knee position during static trials significantly affected the 1st peak EKAM, KAAI, and other knee kinematics and kinetics variables during gait. Therefore, future studies should consider keeping the participants' knees in a consistent position during static trials between visits, as the variations in knee position could mask or exaggerate the differences between groups and interventions.
定量三维步态分析已被用于评估膝关节炎（OA）患者平地行走时膝关节的受力情况（即膝关节外展力矩，EKAM）。EKAM 的大小可能受到一些因素的影响，例如静态校准试验中膝关节标记位置和足部放置角度，这可能导致功能评估和干预计划不准确。本研究旨在阐明静态校准试验中膝关节位置对内侧膝 OA 患者步态中膝关节受力评估的影响。17 名内侧膝 OA 患者在行走前分别完成三种不同的静态站立试验：（1）膝关节 0 度弯曲，（2）膝关节 15 度弯曲，（3）膝关节 30 度弯曲。使用十六个摄像机三维 VICON 步态分析系统和四个 AMTI 力台收集 EKAM、膝关节内收角冲量（KAAI）、膝关节中心（KJC）和其他膝关节运动学和动力学变量。采用重复测量方差分析比较不同条件下的差异。与 0 度条件相比，15 度和 30 度条件下 EKAM 的第 1 个峰值、EKAM 臂的第 1 个峰值、KAAI 和膝关节伸展力矩明显增加（P<0.05）。此外，与 0 度条件相比，15 度和 30 度条件下膝关节屈曲力矩和膝关节外旋力矩明显减小（P<0.05）。所有生物力学变量都受到静态校准试验中 KJC 定位的影响。静态试验中膝关节位置的变化显著影响了步态中 EKAM 的第 1 个峰值、KAAI 和其他膝关节运动学和动力学变量。因此，未来的研究应该考虑在每次就诊时保持参与者膝关节在静态试验中的一致位置，因为膝关节位置的变化可能掩盖或夸大组间和干预间的差异。
