Increased hip internal abduction moment and reduced speed are the gait strategies used by women with knee osteoarthritis

The purpose of this study was to identify the gait strategies in women with mild and moderate knee osteoarthritis (OA). Forty women diagnosed with OA of the knee and 40 healthy women participated in the study. Toe-out progression angle, trunk lateral lean, hip internal abduction moment and gait speed were measured using Qualisys ProReflex System and two force plates. Principal component analysis was applied to extract features from the gait waveforms data that characterized the waveforms main modes of temporal variation. Discriminant analysis with a stepwise model was conducted to determine which strategies could best discriminate groups. According to the discriminant model, the PC2 of the internal abduction moment of the hip and the gait speed were the most discriminatory variables between the groups. The OA group showed decreased gait speed, decreased hip internal abduction moment during the loading response phase, and increased hip internal abduction moment during the mid and terminal stance phases. Interventions that may increase hip internal abduction moment, such as the strengthening of the hip abductors muscles, may benefit women with knee OA. Training slower than normal gait speeds must be considered in light of potential adverse implications on overall physical function, daily tasks, and safety.     

Effects of bilateral medial knee osteoarthritis on intra- and inter-limb contributions to body support during gait

Patients with knee OA show altered gait patterns, affecting their quality of living. The current study aimed to quantify the effects of bilateral knee OA on the intra-limb and inter-limb sharing of the support of the body during gait. Fifteen patients with mild, 15 with severe bilateral knee OA, and 15 healthy controls walked along a walkway while the kinematic and kinetic data were measured. Compared with the controls, the patients significantly reduced their knee extensor moments and the corresponding contributions to the total support moment in the sagittal plane (p<0.05). For compensation, the mild OA group significantly increased the hip extensor moments (p<0.05) to maintain close-to-normal support and a more symmetrical inter-limb load-sharing during double-limb support. The severe OA group involved compensatory actions of both the ankle and hip, but did not succeed in maintaining a normal sagittal total support moment during late stance, nor a symmetrical inter-limb load-sharing during double-limb support. In the frontal plane, the knee abductor moments and the corresponding contributions to the total support moment were not affected by the changes in the other joints, regardless of the severity of the disease. The observed compensatory changes suggest that strengthening of weak hip muscles is essential for body support during gait in patients with knee OA, but that training of weak ankle muscles may also be needed for patients with severe knee OA.     

下肢机器人辅助步态训练联合体外冲击波穴位治疗老年膝骨关节炎的临床研究

摘要 目的：探讨下肢机器人辅助步态训练联合体外冲击波穴位治疗老年膝骨关节炎的临床效果。方法：选取2022.5-2024.5收治的62例老年膝骨关节炎患者,为观察组与对照组,各31例。对照组采用体外冲击波穴位治疗,观察组采用下肢机器人辅助步态训练联合体外冲击波穴位治疗,对比相关指标。结果：观察组总有效率高于对照（P＜0.05）;治疗后,观察组AROM、PROM高于对照组,两组治疗后高于治疗前（P＜0.05）;治疗后,观察组LKSS评分、6米步速高于对照组,两组LKSS评分治疗后高于治疗前（P＜0.05）,观察组6米步速治疗后高于治疗前（P＜0.05）;治疗后,观察组日常生活能力优于对照组（P＜0.05）。结论：下肢机器人辅助步态训练联合体外冲击波穴位治疗老年膝骨关节炎疗效显著,可提升膝关节活动度,改善膝关节功能与步行功能,进而提升日常生活能力。     

How to measure responses of the knee to lateral perturbations during gait? A proof-of-principle for quantification of knee instability

Knee instability is a major problem in patients with anterior cruciate ligament injury or knee osteoarthritis. A valid and clinically meaningful measure for functional knee instability is lacking. The concept of the gait sensitivity norm, the normalized perturbation response of a walking system to external perturbations, could be a sensible way to quantify knee instability. The aim of this study is to explore the feasibility of this concept for measurement of knee responses, using controlled external perturbations during walking in healthy subjects.Nine young healthy participants walked on a treadmill, while three dimensional kinematics were measured. Sudden lateral translations of the treadmill were applied at five different intensities during stance. Right knee kinematic responses and spatio-temporal parameters were tracked for the perturbed stride and following four cycles, to calculate perturbation response and gait sensitivity norm values (i.e. response/perturbation) in various ways.The perturbation response values in terms of knee flexion and abduction increased with perturbation intensity and decreased with an increased number of steps after perturbation. For flexion and ab/adduction during midswing, the gait sensitivity norm values were shown to be constant over perturbation intensities, demonstrating the potential of the gait sensitivity norm as a robust measure of knee responses to perturbations.These results show the feasibility of using the gait sensitivity norm concept for certain gait indicators based on kinematics of the knee, as a measure of responses during perturbed gait. The current findings in healthy subjects could serve as reference-data to quantify pathological knee instability.     

miR-29a对于膝关节骨性关节炎大鼠滑膜损伤中的保护作用研究

摘要 目的：探讨miR-29a对于膝关节骨性关节炎（KOA）大鼠滑膜损伤中的保护作用研究。方法：采用前交叉韧带横断法（ACLT）建立KOA大鼠模型。大鼠注射microRNA阴性对照和miR-29a。通过实时定量聚合酶链反应（RT-qPCR）检测KOA滑膜组织和滑膜细胞中miR-29a的表达。RT-qPCR和蛋白免疫印迹试验检测Toll样受体4/髓样分化蛋白88/核因子κB（TLR4/Myd88/NF-κB）信号通路相关蛋白的表达。检测KOA滑膜组织及滑膜细胞中炎症因子的表达水平。结果：KOA滑膜组织和滑膜细胞中miR-29a表达下调。上调miR-29a可抑制KOA大鼠滑膜细胞的炎症反应,促使KOA大鼠的TLR4/Myd88/NF-κB信号通路失活。结论：上调miR-29a可通过TLR4/Myd88/NF-κB信号通路失活化抑制KOA大鼠滑膜细胞炎症反应,从而保护滑膜损伤。     

Bilateral knee osteoarthritis does not affect inter-joint coordination in older adults with gait deviations during obstacle-crossing

Fifteen elderly subjects with bilateral medial knee osteoarthritis (OA) and 15 healthy elderly subjects walked and crossed obstacles with heights of 10%, 20%, and 30% of their leg lengths while sagittal angles and angular velocities of each joint were measured and their phase angles () calculated. Continuous relative phase (CRP) were also obtained, i.e., _hip−knee and _knee−ankle. The standard deviations of the CRP curve points were averaged to obtain deviation phase (DP) values for the stance and swing phases. Significant differences between the OA and control groups were found in several of the peak and crossing angles, and angular velocities at the knee and ankle. Both groups had similar CRP patterns, and the DP values of the hip–knee and knee–ankle CRP curves were not significantly different between the two groups. Despite significant changes in the joint kinematics, knee OA did not significantly change the way the motions of the lower limb joints are coordinated during obstacle-crossing. It appears that the OA groups adopted a particular biomechanical strategy among all possible strategies that can accommodate the OA-induced changes of the knee mechanics using unaltered inter-joint coordination control. This enabled the OA subjects to accommodate reliably the mechanical demands related to bilateral knee OA in the sagittal plane during obstacle-crossing. Maintaining normal and reliable inter-joint coordination may be considered a goal of therapeutic intervention, and the patterns and variability of inter-joint coordination can be used for the evaluation of treatment effects.     

Ligaments and articular contact guide passive knee flexion

The aim of this study was to test the hypothesis that the coupled features of passive knee flexion are guided by articular contact and by the isometric fascicles of the ACL, PCL and MCL. A three-dimensional mathematical model of the knee was developed, in which the articular surfaces in the lateral and medial compartments and the isometric fascicles in the ACL, PCL and MCL were represented as five constraints in a one degree-of-freedom parallel spatial mechanism. Mechanism analysis techniques were used to predict the path of motion of the tibia relative to the femur. Using a set of anatomical parameters obtained from a cadaver specimen, the model predicts coupled internal rotation and ab/adduction with flexion. These predictions correspond well to measurements of the cadaver specimen’s motion. The model also predicts posterior translation of contact on the tibia with flexion. Although this is a well-known feature of passive knee flexion, the model predicts more translation than has been reported from experiments in the literature. Modelling of uncertainty in the anatomical parameters demonstrated that the discrepancy between theoretical predictions and experimental measurement can be attributed to parameter sensitivity of the model. This study shows that the ligaments and articular surfaces work together to guide passive knee motion. A principal implication of the work is that both articular surface geometry and ligament geometry must be preserved or replicated by surgical reconstruction and replacement procedures to ensure normal knee kinematics and by extension, mechanics.