The Effect of Knee Height Asymmetry on Gait Biomechanics.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-08-01 Epub Date: 2024-05-06 DOI:10.1097/BPO.0000000000002704

Haluk Altiok, Robert Burnham, Jacqueline C Simon, Ann Flanagan, Abdal Kawaiah, Susan Sienko, Cathleen Buckon, Jeremy P Bauer, Karen M Kruger, Joseph J Krzak

{"title":"The Effect of Knee Height Asymmetry on Gait Biomechanics.","authors":"Haluk Altiok, Robert Burnham, Jacqueline C Simon, Ann Flanagan, Abdal Kawaiah, Susan Sienko, Cathleen Buckon, Jeremy P Bauer, Karen M Kruger, Joseph J Krzak","doi":"10.1097/BPO.0000000000002704","DOIUrl":null,"url":null,"abstract":"Background: Though the primary goal for limb length discrepancy (LLD) management is to equalize the leg lengths, symmetry between corresponding long bones is usually not achieved, leading to knee height asymmetry (KHA). To date, there is minimal information on what effect KHA has on gait biomechanics and joint loading. Thus, the purpose of this study is to determine the impact of KHA on gait biomechanics.Methods: Seventeen subjects with KHA after limb equalizing surgery and 10 healthy controls were enrolled. Subjects participated in 3D gait analysis collected using self-selected speed. Lower extremity kinematics, kinetics, work generated/absorbed, and total work were calculated. Standing lower limb x-rays and scanograms were used to measure LLD and calculate the tibia-to-femur (TF) ratio for each limb. Two sample t tests were used to compare differences in standing LLD, TF ratio, and work between groups. Bivariate correlation using Pearson correlation coefficients was conducted between TF ratio and total mechanical work, as well as between knee height asymmetry indices and total work asymmetry (α=0.05).Results: Among participants, there were no differences between LLD; however, there were differences between TF ratio and knee height asymmetry. We found a nonsignificant relationship between TF ratio and total mechanical work for individual lower extremities. Therefore, the length of individual bones (TF ratio) relative to each other within the individual lower extremity was not associated with the amount of work produced. However, when a difference exists between sides (asymmetry, ie, TF ratio asymmetry), there were associated differences in work (work asymmetry) produced between sides (r=0.54, P =0.003). In other words, greater knee height asymmetry between limbs resulted in more asymmetrical mechanical work during walking.Conclusions: These findings may have implications for the management of LLD. Asymmetrical total mechanical work could lead to atypical joint loading during gait. Surgeons may want to consider prioritizing achieving knee height symmetry as a postoperative goal when correcting limb length discrepancy.Level of evidence: Level III, Case Control Study.","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BPO.0000000000002704","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Though the primary goal for limb length discrepancy (LLD) management is to equalize the leg lengths, symmetry between corresponding long bones is usually not achieved, leading to knee height asymmetry (KHA). To date, there is minimal information on what effect KHA has on gait biomechanics and joint loading. Thus, the purpose of this study is to determine the impact of KHA on gait biomechanics.

Methods: Seventeen subjects with KHA after limb equalizing surgery and 10 healthy controls were enrolled. Subjects participated in 3D gait analysis collected using self-selected speed. Lower extremity kinematics, kinetics, work generated/absorbed, and total work were calculated. Standing lower limb x-rays and scanograms were used to measure LLD and calculate the tibia-to-femur (TF) ratio for each limb. Two sample t tests were used to compare differences in standing LLD, TF ratio, and work between groups. Bivariate correlation using Pearson correlation coefficients was conducted between TF ratio and total mechanical work, as well as between knee height asymmetry indices and total work asymmetry (α=0.05).

Results: Among participants, there were no differences between LLD; however, there were differences between TF ratio and knee height asymmetry. We found a nonsignificant relationship between TF ratio and total mechanical work for individual lower extremities. Therefore, the length of individual bones (TF ratio) relative to each other within the individual lower extremity was not associated with the amount of work produced. However, when a difference exists between sides (asymmetry, ie, TF ratio asymmetry), there were associated differences in work (work asymmetry) produced between sides (r=0.54, P =0.003). In other words, greater knee height asymmetry between limbs resulted in more asymmetrical mechanical work during walking.

Conclusions: These findings may have implications for the management of LLD. Asymmetrical total mechanical work could lead to atypical joint loading during gait. Surgeons may want to consider prioritizing achieving knee height symmetry as a postoperative goal when correcting limb length discrepancy.

Level of evidence: Level III, Case Control Study.

查看原文本刊更多论文

膝高不对称对步态生物力学的影响

背景：虽然肢长不一致（LLD）治疗的主要目标是平衡腿长，但通常无法实现相应长骨之间的对称，从而导致膝高不对称（KHA）。迄今为止，有关 KHA 对步态生物力学和关节负荷有何影响的信息极少。因此，本研究旨在确定 KHA 对步态生物力学的影响：方法：研究人员招募了 17 名肢体矫形手术后患有 KHA 的受试者和 10 名健康对照组受试者。受试者使用自选速度进行三维步态分析。计算下肢运动学、动力学、产生/吸收的功和总功。站立时的下肢 X 光片和扫描图用于测量 LLD 和计算每个肢体的胫骨-股骨（TF）比率。采用双样本 t 检验比较各组间站立 LLD、TF 比值和工作量的差异。使用皮尔逊相关系数对 TF 比值和机械总功以及膝高不对称指数和总功不对称进行双变量相关性分析（α=0.05）：在参与者中，LLD 之间没有差异；但 TF 比率和膝高不对称之间存在差异。我们发现，TF 比值与单个下肢的总机械功之间的关系并不显著。因此，在单个下肢中，单个骨骼的相对长度（TF 比）与产生的功量无关。然而，当两侧之间存在差异（不对称，即 TF 比值不对称）时，两侧之间产生的功（功不对称）也存在相关差异（r=0.54，P=0.003）。换句话说，肢体间膝高不对称程度越大，行走时产生的机械功越不对称：这些发现可能对 LLD 的治疗有一定的意义。不对称的总机械功可能会导致步态过程中的非典型关节负荷。外科医生在矫正肢长不一致时，可能要考虑将实现膝高对称作为术后目标的优先考虑因素：三级，病例对照研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.