Valente Giordano, Grenno Giulia, Benedetti Maria G, Dal Fabbro Giacomo, Grassi Alberto, Leardini Alberto, Taddei Fulvia, Zaffagnini Stefano
Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Physical Medicine and Rehabilitation, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Bone Jt Open. 2025 Apr 18;6(4):454-462. doi: 10.1302/2633-1462.64.BJO-2024-0189.R1.
Patients with knee osteoarthritis (OA) and varus deformity present altered gait parameters, especially a large knee adduction moment that is predictive of OA progression. The distinct role of each coexisting parameter, such as OA grade, varus deformity, and previous meniscectomy, in the setting of high tibial osteotomy is not clear. Therefore, the aim of this study was to analyze the motor function parameters in patients eligible for high tibial osteotomy during walking, stair ascending, and stair descending, and to evaluate the effect of OA grade, varus deformity, and meniscectomy.
A total of 52 patients with knee OA and varus deformity participated in this study, including 22 with previous partial meniscectomy, alongside 20 healthy controls. Imaging and motion-capture data during walking, stair ascending, and descending were acquired. Subject characteristics, joint kinematics, joint kinetics, and electromyography on-off activities were compared to evaluate statistically significant differences between the patients and healthy groups. Additionally, multiple linear regression evaluated the relationships between OA grade, varus deformity, and previous meniscectomy with motor function parameters.
The patients group showed significantly higher knee adduction and rotation moments, lower hip adduction and ankle inversion, and higher knee adduction and trunk flexion compared with the healthy group, as well as significantly increased biceps femoris activity. In addition, larger varus deformity showed a more marked effect on the major motor function parameters compared with OA grade and previous meniscectomy, especially during walking.
Patients eligible for high tibial osteotomy move with altered motor function during daily activities, and the coexisting factors of OA grade, varus malalignment, and previous meniscectomy have different impacts, with varus deformity primarily affecting motor function. These findings help to detect the target that should be considered priority in the treatment of high tibial osteotomy, and highlight the importance of realigning the lower limb to possibly restore motor function.
膝骨关节炎（OA）伴内翻畸形患者存在步态参数改变，尤其是较大的膝关节内收力矩，这可预测OA进展。在高位胫骨截骨术中，每个共存参数（如OA分级、内翻畸形和既往半月板切除术）的独特作用尚不清楚。因此，本研究的目的是分析适合高位胫骨截骨术的患者在行走、上楼梯和下楼梯时的运动功能参数，并评估OA分级、内翻畸形和半月板切除术的影响。
共有52例膝OA伴内翻畸形患者参与本研究，其中22例有既往部分半月板切除术，另有20例健康对照者。采集了行走、上楼梯和下楼梯过程中的影像学和运动捕捉数据。比较受试者特征、关节运动学、关节动力学和肌电图开关活动，以评估患者组与健康组之间的统计学显著差异。此外，多元线性回归评估了OA分级、内翻畸形和既往半月板切除术与运动功能参数之间的关系。
与健康组相比，患者组的膝关节内收和旋转力矩显著更高，髋关节内收和踝关节内翻更低，膝关节内收和躯干屈曲更高，股二头肌活动也显著增加。此外，与OA分级和既往半月板切除术相比，更大的内翻畸形对主要运动功能参数的影响更明显，尤其是在行走过程中。
适合高位胫骨截骨术的患者在日常活动中运动功能发生改变，OA分级、内翻畸形和既往半月板切除术等共存因素有不同影响，内翻畸形主要影响运动功能。这些发现有助于确定高位胫骨截骨术治疗中应优先考虑的目标，并强调矫正下肢对线以恢复运动功能的重要性。
