Altered frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during downhill gait in patients with mixed knee osteoarthritis.
Altered frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during downhill gait in patients with mixed knee osteoarthritis.
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DOI：
10.1016/j.jbiomech.2015.05.015
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发表时间：
2015-07-16
影响因子：
2.4
通讯作者：
Tashman S
中科院分区：
文献类型：
--
作者：
Farrokhi S;Meholic B;Chuang WN;Gustafson JA;Fitzgerald GK;Tashman S
膝骨性关节炎的患者通常表现为胫股关节和髌股关节混合疾病的迹象。已有研究表明，改变的额面和横面膝关节力学在膝关节骨性关节炎的特定类型中起着关键作用，但支持这一前提的活体证据仍然有限。本研究的目的是利用动态立体X线技术，比较三组老年人在下坡步态负荷反应阶段的正横平面胫股运动学和髌股对齐情况：11例合并胫股内侧骨性关节炎的患者(n=11)；10例合并胫股外侧间隔室的患者(n=10)和22例无骨关节炎的对照组(n=22)。与内侧室骨关节炎和对照组相比，外侧骨性关节炎患者行走时胫股外展程度更大且增加。此外，与对照组相比，内侧和外侧骨性关节炎组的胫股内旋转度降低。在下坡步态的负荷反应阶段，内侧和外侧骨性关节炎组的步行也表现为外侧倾斜和内侧平移程度的增加。我们的发现表明，尽管内侧和外侧骨性关节炎患者的额面和横面胫股运动学有所不同，但他们的关节错位似乎是相似的。需要进一步的研究来确定这些运动学变化是否为干预措施的相关靶点，以减少混合性疾病患者的疼痛和疾病进展。
Patients with knee osteoarthritis often present with signs of mixed tibiofemoral and patellofemoral joint disease. It has been suggested that altered frontal and transverse plane knee joint mechanics play a key role in compartment-specific patterns of knee osteoarthritis, but invivo evidence in support of this premise remains limited. Using Dynamic Stereo X-ray techniques, the aim of this study was to compare the frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during the loading response phase of downhill gait in three groups of older adults: patients with medial tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=11); patients with lateral tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=10); and an osteoarthritis-free control group (n=22). Patients with lateral compartment osteoarthritis walked with greater and increasing degrees of tibiofemoral abduction compared to the medial compartment osteoarthritis and the control groups who walked with increasing degrees of tibiofemoral adduction. Additionally, the medial and lateral compartment osteoarthritis groups demonstrated reduced degrees of tibiofemoral internal rotation compared to the control group. Both medial and lateral compartment osteoarthritis groups also walked with increasing degrees of lateral patella tilt and medial patella translation during the loading response phase of downhill gait. Our findings suggest that despite the differences in frontal and transverse plane tibiofemoral kinematics between patients with medial and lateral compartment osteoarthritis, the malalignments of their arthritic patellofemoral joint appears to be similar. Further research is needed to determine if these kinematic variations are relevant targets for interventions to reduce pain and disease progression in patients with mixed disease.