Decreased knee adduction moment does not guarantee decreased medial contact force during gait.
Decreased knee adduction moment does not guarantee decreased medial contact force during gait.
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DOI：
10.1002/jor.21142
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发表时间：
2010-10
影响因子：
2.8
通讯作者：
Fregly, Benjamin J.
中科院分区：
文献类型：
--
作者：
Walter, Jonathan P.;D'Lima, Darryl D.;Colwell, Clifford W., Jr.;Fregly, Benjamin J.
过大的接触力被认为是导致膝关节内侧间隙骨关节炎的原因之一。膝关节外收力矩已被认为是步态过程中内侧接触力的替代指标，异常大的峰值与疼痛增加和疾病进展速度有关。这项研究使用从受试者体内采集的测力膝关节植入物的步态数据来评估膝关节内收力矩是否减少，准确地预测相应的内侧接触力的减少。根据受试者的正常步态，对步态改变产生的两个量的变化进行了统计分析。两种步态修改是“内侧推力”步态和“走杆”步态，前者涉及站立阶段的膝盖内侧，后者涉及使用双侧步行杆。膝关节内收力矩的第一个(最大)峰值的减少(32%~33%)与内侧接触力的第一个峰值的减少并不对应。相反，膝关节内收力矩的第二峰值和角冲量的减少(15%到47%)对应于内侧接触力的第二峰值和冲量的减少(12%到42%)。计算的两个膝关节内收力矩峰值的减少对小腿参照系围绕小腿上下轴的旋转高度敏感。结合膝关节外收力矩峰值和膝关节外屈曲力矩绝对值峰值预测两个内侧接触力峰值的效果最好(R2=0.93)。未来评估步态改变对减轻膝关节内侧间隙负荷的有效性的研究应该考虑这两个膝关节瞬间的综合影响。
Excessive contact force is believed to contribute to the development of medial compartment knee osteoarthritis. The external knee adduction moment has been identified as a surrogate measure for medial contact force during gait, with an abnormally large peak value being linked to increased pain and rate of disease progression. This study uses in vivo gait data collected from a subject with a force-measuring knee implant to assess whether knee adduction moment decreases accurately predict corresponding decreases in medial contact force. Changes in both quantities generated via gait modification were analyzed statistically relative to the subject’s normal gait. The two gait modifications were a “medial thrust” gait involving knee medialization during stance phase and a “walking pole” gait involving use of bilateral walking poles. Reductions in the first (largest) peak of the knee adduction moment (32 to 33%) did not correspond to reductions in the first peak of medial contact force. In contrast, reductions in the second peak and angular impulse of the knee adduction moment (15 to 47%) corresponded to reductions in the second peak and impulse of medial contact force (12 to 42%). Calculated reductions in both knee adduction moment peaks were highly sensitive to rotation of the shank reference frame about the superior-inferior axis of the shank. Both peaks of medial contact force were best predicted by a combination of peak values of the external knee adduction moment and peak absolute values of the external knee flexion moment (R2 = 0.93). Future studies that evaluate the effectiveness of gait modifications for offloading the medial compartment of the knee should consider the combined effect of these two knee moments.
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