Ritzmann Ramona, Paul Jochen, Gasser Jürg, Kuch Janine, Li Yufei, Honorio Ines, Beretta-Picoli Agnese, Doelemeyer Arno, Meyer Angelika, Hils Lukas, Utzinger Stefan, Heitner Albrecht, Jacobi Carsten, Centner Christoph
Praxisklinik Rennbahn, Muttenz, Switzerland.
Praxisklinik Rennbahn, Muttenz, Switzerland.
J Biomech. 2025 Mar;181:112546. doi: 10.1016/j.jbiomech.2025.112546. Epub 2025 Jan 22.
Previous evidence highlights the important role of knee joint malalignment and excessive joint moments for the development to knee osteoarthritis. The present study aimed to systematically investigate the interrelationship between three-dimensional knee kinematics during walking and stair climbing and ex-vivo electromechanical measured cartilage quality in 119 patients with end-stage knee osteoarthritis. Patients scheduled for total knee arthroplasty surgery underwent radiographic assessment and biomechanical analysis in gait and stair climbing assessing in vivo knee joint angles and moments during movement dynamics prior to surgery. Electromechanical properties of the excised tibial cartilage as an indicator of cartilage quality were evaluated using Arthro-BST. Peak knee adduction angle was found to be a significant predictor of medial cartilage quality during walking (R = 22 %, p < 0.001) and stair climbing (R = 13 %, p < 0.001). During walking, knee flexion moment was found to be a strong predictor of medial (R = 9 %, p = 0.002) and lateral cartilage quality (R = 12 %, p < 0.001). Knee adduction (R = 19 %, p < 0.001) and abduction angles (R = 44 %, p < 0.01) during x-ray was significantly associated with dynamic assessments during 3D kinematics. Medial joint space width significantly predicted medial tibial cartilage quality (R = 16 %, p < 0.001). The results showed that biomechanical parameters such as varus malalignment during walking and stair climbing are significantly associated with tibial cartilage deterioration and contribute to a variance explanation of 13-22%.
先前的证据突出了膝关节排列不齐和过度的关节力矩在膝关节骨关节炎发展过程中的重要作用。本研究旨在系统地调查119例终末期膝关节骨关节炎患者在行走和爬楼梯过程中的三维膝关节运动学与体外机电测量的软骨质量之间的相互关系。计划进行全膝关节置换手术的患者在术前接受了影像学评估和步态及爬楼梯时的生物力学分析，评估了运动动力学过程中的体内膝关节角度和力矩。使用Arthro - BST评估切除的胫骨软骨的机电特性，作为软骨质量的指标。发现膝关节内收角峰值是行走（R = 22%，p < 0.001）和爬楼梯（R = 13%，p < 0.001）过程中内侧软骨质量的重要预测指标。在行走过程中，发现膝关节屈曲力矩是内侧（R = 9%，p = 0.002）和外侧软骨质量（R = 12%，p < 0.001）的有力预测指标。X线检查时的膝关节内收（R = 19%，p < 0.001）和外展角度（R = 44%，p < 0.01）与三维运动学中的动态评估显著相关。内侧关节间隙宽度显著预测了内侧胫骨软骨质量（R = 16%，p < 0.001）。结果表明，行走和爬楼梯过程中的内翻排列不齐等生物力学参数与胫骨软骨退变显著相关，并且对变异的解释率为13 - 22%。
