Contributions of muscles and external forces to medial knee load reduction due to osteoarthritis braces
Contributions of muscles and external forces to medial knee load reduction due to osteoarthritis braces
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DOI：
10.1016/j.knee.2019.04.006
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发表时间：
2019-06-01
期刊：
影响因子：
1.9
通讯作者：
Deluzio, Kevin J.
中科院分区：
文献类型：
--
作者：
Brandon, Scott C. E.;Brown, Marcus J.;Deluzio, Kevin J.
背景资料：内侧膝关节骨关节炎的支具可以通过三种机制的组合来减少内侧关节负荷：应用外部支具外展力矩、改变步态动力学和减少拮抗肌的激活。虽然膝关节支撑的效果已被独立报道，这些参数中的每一个，没有以前的研究已经量化了他们的相对贡献，以减少内侧膝关节loads.Methods：在这项研究中，我们使用了详细的肌肉骨骼模型，调查即时变化的内侧和外侧负荷所造成的两个不同的膝关节支具：OA辅助和OA调节器3（DJO全球）。17个骨关节炎受试者和18个健康对照进行地上步态试验在unbraced和braced conditions.Results：在所有受试者，支撑减少内侧负荷0.1至0.3倍体重（BW），或大约10%，并增加了0.03至0.2 BW的横向负荷。步态运动学的变化，由于支具是微妙的，并有内侧和外侧关节负荷的影响不大。膝关节内收力矩不变，除非将支具力矩包括在其计算中。只有一个肌肉，股二头肌，表现出一个显着的变化，肌电图与支撑，但这并没有改变峰值内侧接触loads.Conclusions：膝关节支架减少内侧胫股负荷主要是通过施加一个直接的，大量的，外展力矩到每个受试者的膝盖。为了进一步提高支具的有效性，未来的支具设计应该寻求提高这种卸载力矩的大小，并可能利用额外的运动学或神经肌肉步态修改。(C)2019 Elsevier B.V.版权所有。
Background: Braces for medial knee osteoarthritis can reduce medial joint loads through a combination of three mechanisms: application of an external brace abduction moment, alteration of gait dynamics, and reduced activation of antagonistic muscles. Although the effect of knee bracing has been reported independently for each of these parameters, no previous study has quantified their relative contributions to reducing medial knee loads.Methods: In this study, we used a detailed musculoskeletal model to investigate immediate changes in medial and lateral loads caused by two different knee braces: OA Assist and OA Adjuster 3 (DJO Global). Seventeen osteoarthritis subjects and eighteen healthy controls performed overground gait trials in unbraced and braced conditions.Results: Across all subjects, bracing reduced medial loads by 0.1 to 0.3 times bodyweight (BW), or roughly 10%, and increased lateral loads by 0.03 to 0.2 BW. Changes in gait kinematics due to bracing were subtle, and had little effect on medial and lateral joint loads. The knee adduction moment was unaltered unless the brace moment was included in its computation. Only one muscle, biceps femoris, showed a significant change in EMG with bracing, but this did not contribute to altered peak medial contact loads.Conclusions: Knee braces reduced medial tibiofemoral loads primarily by applying a direct, and substantial, abduction moment to each subject's knee. To further enhance brace effectiveness, future brace designs should seek to enhance the magnitude of this unloader moment, and possibly exploit additional kinematic or neuromuscular gait modifications. (C) 2019 Elsevier B.V. All rights reserved.