膝关节骨性关节炎的结构教育和运动治疗干预后，膝关节力矩变化与放射学严重程度和体重的关系

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-07-18 DOI:10.1016/j.clinbiomech.2025.106627

Jacqui M. Couldrick , Andrew P. Woodward , Joseph T. Lynch , Nicholas A.T. Brown , Christian J. Barton , Jennie M. Scarvell

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引用次数: 0

摘要

有证据表明膝关节负荷与膝关节骨性关节炎进展有关，因此减轻负荷成为非手术干预的目标。运动疗法似乎没有减少膝关节力矩，但研究集中在内侧隔室，忽视了其他隔室的严重程度和体重的影响，并且没有评估更苛刻的任务。本研究评估运动治疗后膝关节内收和膝关节屈曲力矩是否减少。我们研究了在更高要求的任务、椅子上升过程中膝关节力矩变化的程度，以及体重和骨关节炎室严重程度的影响。方法对31例膝关节骨性关节炎患者进行三维生物力学分析，分别在基线和丹麦骨性关节炎良好生活干预后第8周进行行走和起立。多层模型估计膝关节内收和膝关节屈曲力矩及其与骨关节炎室严重程度和体重的关系。结果：干预后，在椅子上升过程中，膝关节内收和膝关节屈曲力矩均有所减少。无论骨关节炎腔室严重程度如何，步行时第一个膝关节内收力矩峰值从41.7 Nm （90% CrI 37.0, 46.5）轻微增加3%至43.0 Nm（38.5, 47.5）。更大的外侧和髌股腔隙严重程度与行走和起身时膝关节屈曲力矩减少有关。在这两项任务中，体重与膝关节内收和膝关节屈曲力矩之间的关系都很弱。在干预之后，体重较重的人在走路时增加的幅度更大，但这是不确定的。解释：干预对行走时膝关节内收力矩的影响最小，与骨隔严重程度无关。在椅子上升过程中观察到膝关节力矩的减少。运动治疗后关节负荷的变化可能在高要求的任务中更明显。在苛刻的任务中，膝关节屈曲力矩和关节载荷之间的关系值得进一步研究。

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Knee joint moment changes and the relationship to radiological severity and body weight following a structured education and exercise therapy intervention for knee osteoarthritis

Background

Evidence links knee joint loads to knee osteoarthritis progression, making load reduction a target for non-surgical interventions. Exercise therapy does not appear to reduce knee joint moments, but studies focus on the medial compartment, overlook severity in other compartments and the influence of body weight, and do not assess more demanding tasks. This study evaluated whether knee adduction and knee flexion moments decrease following exercise therapy. We examined the extent to which knee joint moments change during a more demanding task, chair-rise, and the influence of body weight and osteoarthritis compartment severity.

Methods

Thirty-one participants with knee osteoarthritis underwent three-dimensional biomechanical analysis during walking and chair rises at baseline and week-8 after the Good Life with OsteoArthritis in Denmark intervention. Multilevel models estimated knee adduction and knee flexion moments and their relationships with osteoarthritis compartment severity and body weight.

Findings

Both knee adduction and knee flexion moments reduced during chair-rise after the intervention. The first peak knee adduction moment increased slightly by 3 % from 41.7 Nm (90 % CrI 37.0, 46.5) to 43.0 Nm (38.5, 47.5) during walking, regardless of osteoarthritis compartment severity. Greater lateral and patellofemoral compartment severity was related to larger knee flexion moment reductions during walking and chair-rises. Weak relationships were found between body weight and knee adduction and knee flexion moments for both tasks. Following the intervention, heavier people had larger increases during walking, but this was uncertain.

Interpretation

Intervention had minimal impact on the knee adduction moment during walking, regardless of compartment severity. Reductions in knee joint moments were observed during chair-rises. Changes in joint load following exercise therapy may be more apparent during demanding tasks. The relationship between knee flexion moment and joint load during demanding tasks warrants further investigation.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.