Contribution of knee adduction moment impulse to pain and disability in Japanese women with medial knee osteoarthritis

Background

An increase in the knee adduction moment is one of the risk factors of medial knee osteoarthritis. This study examined the relationship between knee adduction moment and self-reported pain and disability. We also investigated the influence of pain on the relationships between knee adduction moment and gait performance and disability.

Methods

Thirty-eight Japanese women with medial knee osteoarthritis participated in this study (66.37 years (41–79 years)). Gait analysis involved the measurement of the external knee adduction moment impulse in the stance duration and during 3 subdivisions of stance. The total, pain and stiffness, and physical function Japanese Knee Osteoarthritis Measure scores were determined.

Findings

The pain and stiffness, physical function, and total scores were positively correlated with the knee adduction moment impulses in the stance duration, and initial and second double support interval, and single limb support interval. The knee adduction moment impulse during the stance duration was related to the pain and stiffness subscale and gait velocity. The pain and stiffness subscale was related to the physical function subscale.

Interpretation

Our results suggest that increasing in the knee adduction moment impulse, a proxy for loading on the medial compartment of the knee, is related to increased pain during weight-bearing activities such as walking, thereby restricting walking performance and causing disability by reducing gait velocity. Thus, the reduction in the knee adduction moment impulse during gait may result in pain relief and may serve as a conservative treatment option with disease-modifying potential.     

不同时期膝关节镜检+单髁关节置换对前内侧间室膝关节骨性关节炎患者膝关节功能的影响

目的 研究不同时期膝关节镜检+单髁关节置换对前内侧间室膝关节骨性关节炎患者膝关节功能的影响。方法 回顾性分析2015年10月－2019年10月该院收治的100例前内侧间室膝关节骨性关节炎患者的临床资料,所有患者均行膝关节镜检+单髁关节置换。其中,56例行同期手术治疗的患者作为观察组（Outerbridge分级为Ⅲ级或Ⅳ级）,44例行分期手术治疗的患者作为对照组（Outerbridge分级为Ⅰ级或Ⅱ级）。比较两组患者的临床疗效、手术相关指标、治疗前及治疗后3、6和12个月的膝关节活动度、治疗前后膝关节功能评分［疼痛视觉模拟评分（VAS）、牛津大学膝关节评分（OKS）和美国西安大略和麦克马斯特大学骨性关节炎指数（WOMAC）评分］,以及术后并发症发生情况。结果 观察组总有效率为94.64%,与对照组的88.64%比较,差异无统计学意义（P > 0.05）。观察组手术时间和住院时间短于对照组,差异有统计学意义（P < 0.05）。两组患者治疗后3、6和12个月膝关节活动度较治疗前增大,差异有统计学意义（P < 0.05）,但不同时期组间比较,差异无统计学意义（P > 0.05）。两组患者治疗后VAS、OKS和WOMAC评分较治疗前降低（P < 0.05）;观察组治疗后WOMAC和OKS评分较对照组低（P < 0.05）;两组患者VAS比较,差异无统计学意义（P > 0.05）。患者均未发生严重并发症,两组患者并发症发生率比较,差异无统计学意义（P > 0.05）。结论 同期与分期行膝关节镜检+单髁关节置换治疗前内侧间室膝关节骨性关节炎,临床疗效相当,但同期膝关节镜检 + 单踝关节置换可促进膝关节功能恢复,值得临床推广。     

Comparison of peak knee adduction moment and knee adduction moment impulse in distinguishing between severities of knee osteoarthritis

Background

The peak knee adduction moment is a valid proxy for medial knee joint loading. However as it only measures load at one instance of stance, knee adduction moment impulse, a measure that takes into account both the magnitude and duration of the stance phase, may provide more comprehensive information. This study directly compared the abilities of peak knee adduction moment and knee adduction moment impulse to distinguish between knee osteoarthritis severities.

Methods

169 participants with medial knee osteoarthritis completed radiographic and magnetic resonance imaging, the Western Ontario and McMaster Universities Arthritis Index to assess pain and a three-dimensional gait analysis. Participants were classified using four dichotomous classifications: Kellgren–Lawrence grading, alignment, medial tibiofemoral bone marrow lesions, and pain.

Findings

When using Kellgren–Lawrence grade and alignment classifications, the area under the receiver operator curves were significantly greater for knee adduction moment impulse than for peak knee adduction moment. Based on analysis of covariance, knee adduction moment impulse was significantly different between Kellgren–Lawrence grade and alignment groups while peak knee adduction moment was not significantly different. Both peak knee adduction moment and knee adduction moment impulse distinguished between bone marrow lesion severities while neither measure was significantly different between pain severity groups.

Interpretations

Findings suggest knee adduction moment impulse is more sensitive at distinguishing between disease severities and may provide more comprehensive information on medial knee joint loading. Future studies investigating biomechanics of knee osteoarthritis should include knee adduction moment impulse in conjunction with peak knee adduction moment.     

Hip abductor function in individuals with medial knee osteoarthritis: Implications for medial compartment loading during gait

Background

Hip abductor muscles generate moments of force that control lower extremity frontal plane motion. Strengthening these muscles has been a recent trend in therapeutic intervention studies for knee osteoarthritis. The current study investigated the relationship between hip abductor muscle function (strength and activation) and the net external knee adduction moment during gait in those with medial compartment knee osteoarthritis.

Methods

54 individuals with moderate knee osteoarthritis walked at their self-selected velocity while gluteus medius electromyograms, segment motions and ground reaction forces were recorded. Net external knee adduction moment (KAM) and linear enveloped electromyographic profiles were calculated. Peak KAM was determined and then principal component analyses (PCA) were applied to KAM and electromyographic profiles. Isometric hip abductor strength, anthropometrics and gait velocity were measured. Multiple regression models evaluated the relationship between walking velocity, hip abductor strength, electromyographic variables recorded during gait and KAM waveform characteristics.

Findings

Minimal peak KAM variance was explained by abductor strength (R² = 9%, P = 0.027). PCA-based KAM waveform characteristics were not explained by abductor strength. Overall gluteus medius amplitude (PP1-scores) was related to a reduction in the bi-modal KAM (PP3-scores) pattern (R² = 16%, P = 0.003).

Interpretation

There was no clear relationship between hip abductor muscle strength and specific amplitude and temporal KAM characteristics. Higher overall gluteus medius activation amplitude was related to a sustained KAM during mid-stance. 84 to 90% of the variance in KAM waveform characteristics was not explained by hip abductor muscle function showing hip abductor muscle function has minimal association to KAM characteristics.     

调制中频电疗法对膝骨性关节炎患者疼痛及生存质量的影响

目的:观察调制中频电疗法对膝关节骨性关节炎患者疼痛及生存质量的影响.方法:将60例膝关节骨性关节炎患者随机分为调制中频电治疗组和对照组,每组各30例.治疗组采用调制中频电治疗,两组临床用药及常规康复治疗相同.两组患者分别在入组时及第7次、第14次、第20次治疗结束时,采用简化McGill疼痛问卷和生存质量量表简表进行疼痛和生存质量的评估.结果:在缓解疼痛方面,治疗7次、14次及20次时,治疗组与对照组患者的McGill疼痛量表评分相比差异均有显著性(P＜0.05);在提高生存质量方面,治疗7次时治疗组与对照组患者的生存质量评分相比差异无显著性(P＞0.05):而治疗至14次及20次时,治疗组与对照组患者的生存质量评分相比差异均表现出显著性(P＜0.05).结论:调制中频电疗法能显著缓解膝关节骨性关节炎患者疼痛,并提高患者的生存质量.     

不同外侧楔形矫形鞋垫对内侧间室膝骨性关节炎患者步态的影响

目的:通过比较早期内侧间室膝骨性关节炎患者在佩戴传统与新型外侧楔形角矫形鞋垫(LW)后步行过程中所产生的下肢生物力学变化及差异,探讨新型设计的LW在早期内侧间室骨关节炎康复治疗中的应用价值。方法:采用英国Vicon三维步态分析系统配合Kislter测力台分别测评30例早期内侧间室型膝骨性关节炎患者在佩戴传统LW(楔形角5°)、新型带足弓支撑的LW(楔形角5°)及无佩戴任何矫形器(测试过程中均穿标准鞋)3种不同条件下的下肢关节运动学、动力学及时间空间参数变化。结果:相较于未佩戴任何矫形鞋垫情况,佩戴2种LW后膝关节载荷(膝关节内翻力矩,膝关节内翻角冲量)均显著降低(P<0.05)。此外,佩戴传统的LW后患者步行过程中踝关节外翻角度、外翻力矩及地面反作用力内侧方向较其他2种方式明显增加(P<0.05),而佩戴新型LW后下肢前进角度较其他2种方式显著增加(P<0.05)。结论:两种不同设计的LW均有助于缓解早期内侧间室型膝骨性关节炎患者运动过程中的膝关节载荷,且未见明显差异。但相较于传统外侧楔形矫形鞋垫,带有足弓支撑设计的矫形鞋垫佩戴后更为舒适,且不会引起踝关节内侧应力的增加。     

膝关节骨性关节炎膝屈伸肌力减弱与疼痛程度的关联

目的:评价膝关节骨性关节炎(OA)患者主观疼痛程度与患膝屈伸肌力减弱的关系。方法:单侧膝OA患者42例。以VAS法询问其下蹲、起立动作时的主观疼痛感觉,分为轻度疼痛(00.05外),疼痛越明显,下降程度越显著。结论:膝OA患者的疼痛可导致患侧膝屈伸肌力下降。     

Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis

Fantini Pagani CH, Böhle C, Potthast W, Brüggemann G-P. Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis.

Objective

To analyze knee joint loading, subjective pain relief, and improvements in function in patients with osteoarthritis (OA) with the use of 2 orthosis adjustments.

Design

Patients were tested under 3 different conditions (without orthosis, orthosis at 4° valgus, and a neutral very flexible adjustment) in a crossover trial.

Setting

University gait analysis laboratory with 3-dimensional motion analysis and force platforms.

Participants

Patients (N=11) with a clinical and radiographic diagnosis of unilateral OA in the medial knee compartment.

Interventions

Patients wore a knee orthosis designed to unload the medial knee compartment for 4 weeks in 2 different adjustments (2 weeks in each adjustment).

Main Outcome Measures

Net knee adduction moment and net knee adduction angular impulse during the stance phase were analyzed by using inverse dynamics. Subjective pain relief, stiffness, and function improvement were evaluated using a questionnaire (Western Ontario and McMaster Universities Osteoarthritis Index). A 6-minute walk test and stair-climbing test also were performed.

Results

Both orthosis adjustments induced subjective pain relief and improvement in function compared with the condition without orthosis. Knee adduction moment was significantly decreased with both adjustments, whereas the decrease observed with the 4° valgus adjustment was significantly greater than the flexible adjustment (25% vs 12.5%). Compared with the condition without orthosis, changes in knee adduction angular impulse of 29% and 15% were found with 4° valgus and the neutral flexible orthosis, respectively. Time required for the stair-climbing activity was significantly decreased using the orthosis in 4° valgus adjustment compared with the condition without orthosis. No significant differences were observed among conditions during the 6-minute walk test.

Conclusions

Both orthosis adjustments were effective in decreasing symptoms; however, a decrease in knee loading was more effective using the 4° valgus adjustment, which could contribute to avoidance of disease progression.     

超声波结合经皮神经电刺激对膝骨关节炎患者膝关节疼痛和功能的影响

摘要目的：探讨超声波结合经皮神经电刺激对膝骨关节炎患者膝关节疼痛和功能的影响。方法：将122例Kellgren-Lawrence（K-L）分级1—3级的膝骨关节炎患者随机分为试验组和对照组,每组各61例。试验组患者在常规康复治疗基础上给予超声波结合经皮神经电刺激治疗,对照组患者在常规康复治疗基础上仅给予超声波治疗。2组患者在治疗前、治疗4周后及治疗结束后第3月时,采用VAS疼痛评分量表、WOMAC膝骨关节炎指数、步行能力评定量表、6min步行距离评定患者的膝关节疼痛和功能状况。结果：治疗前,试验组和对照组各项数据相比差异无显著性意义,治疗4周后,两组患者的VAS评分、WOMAC疼痛和功能评分均有明显下降（P<0.05）;两组患者的步行能力评分和6min步行距离均有明显提高（P<0.05）,WOMAC僵硬评分两组患者均无明显改变（P＞0.05）,且试验组联合治疗下的VAS评分 、WOMAC疼痛和功能评分、步行能力评分和6min步行距离与对照组相比均有显著性意义（P＜0.05）。随访时,两组患者除WOMAC僵硬评分和功能评分外其余指标与治疗前比仍有显著性差异（P<0.05）,试验组的VAS评分 、WOMAC疼痛评分、步行能力评分和6min步行距离均优于对照组（P<0.05）。结论：超声波结合经皮神经电刺激可明显改善膝骨关节炎患者的膝关节疼痛、提高其步行功能和步行距离,但对膝关节僵硬无明显改善作用。     

微创截骨手术方案对内侧间室膝关节骨关节炎患者的疗效及满意度的影响

目的探讨微创截骨手术方案对内侧间室膝关节骨关节炎(KOA)患者疗效及满意度的影响。方法研究对象选取该院2016年1月-2017年6月收治的内侧间室KOA患者共140例,以随机数字表法分为对照组(70例)和试验组(70例),分别采用常规截骨手术和关节镜下截骨手术治疗;比较两组术后满意度、手术前后内侧间隙、外翻角、WOMAC评分、Lysholm评分、血清基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶-3(MMP-3)水平及术后并发症发生率。结果两组术后满意度比较,差异无统计学意义(P0.05);两组术后内侧间隙和外翻角比较,差异无统计学意义(P0.05);试验组术后WOMAC和Lysholm评分均明显优于对照组和术前(P 0.05);试验组术后血清MMP-1和MMP-3水平均明显低于对照组和术前(P 0.05);同时两组早期膝关节无力发生率比较,差异无统计学意义(P0.05)。结论微创截骨手术方案治疗内侧间室KOA能够有效缓解相关症状,改善肢体活动功能,且有助于降低血清MMPs水平,价值优于常规截骨手术方案。     

膝骨关节炎和腰痛患者的脑低频振幅影像学特征比较北大核心CSCD

目的基于静息态功能磁共振成像低频振幅(ALFF)分析方法探讨膝骨关节炎(KOA)和腰痛两种慢性疼痛患者脑影像学特征的异同。方法2015年8月至2021年9月在福建福州市各社区招募KOA患者16例及年龄、性别相似的健康人16例(对照组1);从Openpain数据库获得27例腰痛患者和年龄、性别相似的健康人32例(对照组2)。比较受试者的ALFF。采用简明疼痛量表(BPI)对KOA患者进行疼痛评分,采用视觉模拟量表(VAS)对腰痛患者进行疼痛评分,并与ALFF进行相关性分析。结果与各自对照组相比,KOA和腰痛患者左前脑岛ALFF降低,KOA患者海马和后扣带回ALFF降低,腰痛患者升高;KOA患者左楔前叶、左中扣带回、右中脑导水管周围灰质区域ALFF降低,右中央前回、中央后回ALFF升高;腰痛患者双前扣带回、双眶部额前回、左背外侧前额叶、右内侧前额叶ALFF降低,右海马旁回、右杏仁核ALFF升高;KOA患者左中扣带回ALFF与BPI评分负相关(r=-0.73,P=0.003),腰痛患者右海马/杏仁核ALFF与VAS评分正相关(r=0.73,P=0.003)。结论不同类型慢性疼痛有共同和特异的脑影像学特征。前脑岛、海马和后扣带回ALFF改变可能是KOA和腰痛的共同病理机制。     

The association between knee temperature and pain in elders with osteoarthritis of the knee: a pilot study

BACKGROUND: Osteoarthritis is a highly prevalent, disabling condition that causes significant pain and suffering among older adults. Cognitively impaired elders are as susceptible to osteoarthritis as their peers. However, since they have diminished ability to communicate their pain, an alternative method to detect osteoarthritis pain in cognitively impaired elders is urgently needed. Because the late stages of osteoarthritis involve joint inflammation with a mild increase in local temperature, skin surface temperature might reasonably be expected to serve as a proxy measure of osteoarthritis pain. If knee surface temperature could be shown to predict pain in cognitively intact elders, it could be used as a proxy measure of pain for cognitively impaired elders. AIM: To test this, the study reported here assessed the relationship between knee surface temperature and pain in cognitively intact elders with osteoarthritis of the knee. METHODS: We recruited 12 cognitively intact elders with documented osteoarthritis of the knee who lived in retirement apartments. Elders' pain and knee temperature were measured three times on three separate occasions. Osteoarthritis pain of the knee was measured using the Knee Pain Scale and the Western Ontario and McMaster Osteoarthritis Index pain subscale. A YSI Model 4000 Dual Channel Display Telethermometer was used to measure knee temperature. RESULTS: We found no significant associations between knee temperature and any of the pain measures used, with one exception. However, body mass index, amount of pain medication used and activity level observed during the interview were significantly related to elders' pain. CONCLUSION: Knee temperature does not appear to predict knee pain in elders with osteoarthritis of the knee. Body mass index, use of pain medication and activity level are better predictors of this.     

等速向心和离心肌力训练治疗膝关节骨性关节炎患者的有效性研究

目的：比较等速向心和等速离心肌力训练治疗膝关节骨性关节炎（OA）患者的有效性。方法：45例膝OA患者随机分为向心训练组、离心训练组和对照组。向心训练组患者（n=15）接受等速向心肌力训练．离心训练组（n=15）患者接受等速离心肌力训练，每周训练3次，共训练8周。用Biodex等速肌力测试训练系统评价膝OA患者训练前后的膝关节伸肌和屈肌的峰力矩改变。用目测类比评分法和Lequesne指数评价膝OA患者疼痛和功能障碍的改变。结果：两个训练组的膝OA患者的疼痛、功能障碍和肌肉峰力矩在训练后都有明显改善（P〈0．05）。而对照组8周后无明显改变。虽然不同的等速训练方法显示了一定的训练效果特异性．但在两个训练组之间各项参数无显著性差异。结论：等速向心和等速离心肌力训练方案在膝OA的治疗中都是有效的。在等速向心和等速离心训练之间未观察到显著性差异。     

基于rs-fMRI技术探讨臭氧水对膝骨性关节炎疼痛患者镇痛作用的中枢机制

目的利用静息态功能磁共振成像(resting state functional magnetic resonance imaging,rs-fMRI)技术探讨臭氧水对慢性疼痛的膝骨性关节炎(knee osteoarthritis,KOA)患者镇痛作用的中枢效应机制,为临床臭氧水治疗KOA提供理论依据。材料与方法将符合纳入标准的18名KOA患者进行臭氧水关节腔冲洗治疗,每周1次,共治疗3次。分别在治疗前、治疗后行疼痛视觉评分(visual analog scale,VAS)和rs-fMRI扫描;采用局部一致性(regional homogeneity,ReHo)的数据分析方法,分析臭氧水治疗后ReHo显著变化的脑区;并将ReHo与VAS评分变化进行Pearson相关性分析。结果臭氧水治疗后,KOA患者的VAS评分显著降低(P=0.000),枕上回(t=3.69)、枕中回、楔叶、角回等脑区不同区域ReHo值增高(t=4.89),中央沟盖(t=-4.19)、颞上回、中央前回等脑区不同区域ReHo值降低(t=-5.45)。相关性分析结果显示臭氧水治疗后,右岛叶(r=-0.657)ReHo变化与VAS变化呈负相关。结论臭氧水可能是通过调节颞叶、顶叶、额叶、枕叶等脑区的功能达到治疗KOA患者疼痛的作用;而岛叶可能是臭氧水镇痛作用的关键脑区。     

The use of a lateral wedge insole to reduce knee loading when ascending and descending stairs in medial knee osteoarthritis patients

Background

Stair climbing is a challenging task to the elderly being the task with the first complaint in patients with mild to moderate knee osteoarthritis. Stair climbing results in around six times more compressive load transmitted through the knee joint than walking on level ground. The purpose of this study was to assess whether lateral wedge insoles would reduce medial compartment knee loading when ascending and descending stairs in patients with medial knee osteoarthritis.

Methods

Eight patients with medial knee osteoarthritis were tested in random order with and without a pair of 5° off-the-shelf lateral wedge insoles for two separate activities (stair ascent and stair descent). Kinematic and kinetic data were collected for the lower extremity using a sixteen camera motion capture system and two force plates. Primary outcome measures were the external knee adduction moment and the knee adduction angular impulse.

Findings

During stair ascent and descent, lateral wedge insoles significantly (P < 0.05) reduced the 1st peak external knee adduction moment in early stance (ascent 6.8%, descent 8.4%), the trough in mid stance (ascent 13%, descent 10.7%), 2nd peak in the late stance (ascent 15%, descent 8.3%) and the knee adduction angular impulse compared to the control (standard shoe) with large effect sizes (0.75–0.95).

Interpretation

In this first study on stairs, lateral wedge insoles consistently reduced the overall magnitude of medial compartment loading during stair ascent and descent. Further research is needed to determine the relationship of this with clinical results when ascending and descending stairs with lateral wedge insoles.     

Factors associated with stair climbing ability in patients with knee osteoarthritis and knee arthroplasty: a systematic review

Abstract

Purpose: People with knee osteoarthritis (OA) report ongoing limitations in climbing stairs, even after total knee arthroplasty (TKA). The aim of this systematic review was to synthesise the available evidence of factors affecting stair climbing ability in patients with knee OA before and after TKA. Method: A systematic search was conducted of common electronic databases. All English language abstracts where stair-climbing was assessed in patients with either knee OA or at least 6 months after TKA, and a relationship to any physical, psychological or demographic factors was reported. Results: Thirteen studies were included in the final review, nine investigated a knee OA population, and four investigated a TKA population. For patients with knee OA there was consistent and convincing evidence that greater stair-climbing ability was related to stronger lower limb muscles and less knee pain. For patients with TKA there was much less research, and no conclusions could be reached. Conclusions: For people with knee OA there is evidence that some physical, demographic and psychosocial factors are related to stair-climbing ability. However, the evidence for similar relationships in the TKA population is scarce and needs more extensive research.

• Implications for Rehabilitation

• People with knee osteoarthritis experience difficulty when climbing stairs, and this remains challenging even after knee replacement.

• For people with knee osteoarthritis, a range of physical, demographic and psychosocial factors contribute to stair-climbing ability, however, evidence for similar relationships in the TKA population is scarce.

• Rehabilitation that is multi-faceted may be the best approach to improve stair-climbing in people with knee osteoarthritis.