Li Zongpan, Leung Aaron Kam-Lun, Huang Xiuping, Huang Chen, Su Shan, Chung Raymond C K, Ding Changhai, Fu Siu Ngor
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
J Orthop Res. 2025 Jul;43(7):1275-1283. doi: 10.1002/jor.26090. Epub 2025 Apr 28.
Lower strength and higher passive stiffness of the quadriceps have been associated with a higher risk of knee osteoarthritis/pain in aging populations. It is proposed that altered quadriceps properties would cause excessive knee loads, thus contributing to knee mechanical damages, but the relevant evidence is limited. This study aimed to explore relationships amongst quadriceps properties, knee flexions, and knee moments during gait. This study included 87 community-dwelling elders (65.9 ± 4.1 years; 57.5% females). Quadriceps strength was assessed using a Cybex dynamometer, and the passive stiffness of three superficial quadriceps heads was evaluated using shear-wave ultrasound elastography. Gait analysis was conducted to compute the knee adduction moment (KAM), knee flexion moment (KFM), KAM index, and knee flexion excursion (KFE) during the mid-stance phase. Associations amongst quadriceps properties, KFE, and knee moments were examined by partial correlations. Mediation analysis was used to explore the mediating role of KFE in associations between quadriceps properties and knee moments. Greater quadriceps strength was associated with a higher KAM (r = 0.304; p = 0.006). Greater stiffness of the rectus femoris (RF) was indirectly associated with a higher KAM index (mediation-effect [95% CI]: 0.084 [0.011, 0.191], p = 0.017) but a lower KFM (mediation-effect [95% CI]: -0.139 [-0.270, -0.041], p = 0.004), via a smaller KFE. Stronger quadriceps are correlated with a higher frontal knee moment. Stiffer RF is indirectly associated with a higher frontal knee load sharing through reduced sagittal knee motions, which could be a potential mechanism of stiffer RF for knee osteoarthritis.
在老年人群中，股四头肌力量减弱和被动僵硬度增加与膝关节骨关节炎/疼痛风险较高有关。有人提出，股四头肌特性改变会导致膝关节负荷过大，从而造成膝关节机械损伤，但相关证据有限。本研究旨在探讨步态期间股四头肌特性、膝关节屈曲和膝关节力矩之间的关系。本研究纳入了87名社区居住的老年人（65.9±4.1岁；57.5%为女性）。使用Cybex测力计评估股四头肌力量，并使用剪切波超声弹性成像评估股四头肌三个表层肌头的被动僵硬度。进行步态分析以计算站立中期的膝关节内收力矩（KAM）、膝关节屈曲力矩（KFM）、KAM指数和膝关节屈曲 excursion（KFE）。通过偏相关性检验股四头肌特性、KFE和膝关节力矩之间的关联。采用中介分析来探讨KFE在股四头肌特性与膝关节力矩关联中的中介作用。股四头肌力量越大，KAM越高（r = 0.304；p = 0.006）。股直肌（RF）僵硬度增加与较高的KAM指数间接相关（中介效应[95%CI]：0.084[0.011，0.191]，p = 0.017），但与较低的KFM间接相关（中介效应[95%CI]：-0.139[-0.270，-0.041]，p = 0.004），通过较小的KFE。更强壮的股四头肌与更高的额面膝关节力矩相关。更僵硬的RF通过减少矢状面膝关节运动与更高的额面膝关节负荷分担间接相关，这可能是RF僵硬导致膝关节骨关节炎的潜在机制。
