Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: A tri-planar kinetic mechanism
Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: A tri-planar kinetic mechanism
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DOI：
10.1016/j.jbiomech.2007.09.015
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发表时间：
2008-01-01
影响因子：
2.4
通讯作者：
Birmingham, Trevor B.
中科院分区：
文献类型：
--
作者：
Jenkyn, Thomas R.;Hunt, Michael A.;Birmingham, Trevor B.
内侧间隔性膝骨性关节炎患者的步态运动学和动力学改变。虽然各种运动学适应被认为是卸载膝关节的代偿机制，但这些机制的性质目前尚不清楚。我们假设，在步态的早期站立阶段，增加的脚趾外倾角将负荷从膝关节内侧间隙转移开，这被量化为围绕膝盖的外部内收力矩。具体地说，我们假设，通过向外旋转小腿解剖结构，主要围绕髋关节，脚趾向外步态改变了在额面和矢状面上作用于膝关节的地面反作用力杠杆臂的长度，并将膝关节内收瞬间的一部分转换为屈曲瞬间。为了验证这一假设，我们使用两个参照系检查了180名被诊断为膝关节内侧间隔性骨关节炎的受试者的步态数据。第一个框架连接到胫骨(报告实际脚趾外露)，第二个框架连接到实验室(模拟无脚趾外露)。在两个参照系中比较了受试者内部的四个测量：地面反作用力杠杆臂在正面和矢状面作用于膝关节的长度，以及膝关节外收力矩和屈膝分量。平均脚趾外露角度为11.4度(S.D.7.8度，范围-2.2度至28.4度)。与模拟的无脚趾外露值相比，在站立早期阶段，脚尖外露导致前平面杠杆臂(-6.7%)和内收力矩(-11.7%)显著减少。这些减少与矢状面杠杆臂(+33.7%)和屈曲力矩(+25.0%)显著增加一致。峰值内收杠杆臂和力矩在站立晚期也显著降低(分别为-22.9%和-34.4%)，而矢状面杠杆臂和屈曲力矩没有相应的增加。这些结果表明，膝关节内侧骨性关节炎患者的脚趾外伸步态在站立早期将部分内收力矩转换为屈曲力矩，提示负荷部分从内侧间隔区转移到其他结构。(C)2007爱思唯尔有限公司。保留所有权利。
Altered gait kinematics and kinetics are observed in patients with medial compartment knee osteoarthritis. Although various kinematic adaptations are proposed to be compensatory mechanisms that unload the knee, the nature of these mechanisms is presently unclear. We hypothesized that an increased toe-out angle during early stance phase of gait shifts load away from the knee medial compartment, quantified as the external adduction moment about the knee. Specifically, we hypothesized that by externally rotating the lower limb anatomy, primarily about the hip joint, toe-out gait alters the lengths of ground reaction force lever arms acting about the knee joint in the frontal and sagittal planes and transforms a portion of knee adduction moment into flexion moment.To test this hypothesis, gait data from 180 subjects diagnosed with medial compartment knee osteoarthritis were examined using two frames of reference. The first frame was attached to the tibia (reporting actual toe-out) and the second frame was attached to the laboratory (simulating no-toe-out). Four measures were compared within subjects in both frames of reference: the lengths of ground reaction force lever arms acting about the knee joint in the frontal and sagittal planes, and the adduction and flexion components of the external knee moment.The mean toe-out angle was 11.4 degrees (S.D. 7.8 degrees, range -2.2 degrees to 28.4 degrees). Toe-out resulted in significant reductions in the frontal plane lever arm (-6.7%) and the adduction moment (-11.7%) in early stance phase when compared to the simulated no-toe-out values. These reductions were coincident with significant increases in the sagittal plane lever arm (+33.7%) and flexion moment (+25.0%). Peak adduction lever arm and moment were also reduced significantly in late stance phase (by -22.9% and -34.4%, respectively) without a corresponding increase in sagittal plane lever arm or flexion moment. These results indicate that toe-out gait in patients with medial compartment knee osteoarthritis transforms a portion of the adduction moment into flexion moment in early stance phase, suggesting that load is partially shifted away from the medial compartment to other structures. (c) 2007 Elsevier Ltd. All rights reserved.