Background

Attempts to improve protocol standards of marker-based clinical gait analysis (CGA) have been one of the main focuses of research to enhance robustness and reliability outcomes since the 1990s. Determining joint centres and axes constitutes an important aspect of those protocols. Although the hip joint is more prominent in such studies, knee joint center (KJC) and axis (KJA) directly affect all outcomes.

Research question

What recommendations arise from the study of the scientific literature for determining knee joint parameters (KJP) for protocols of CGA?

Methods

A systematic, electronic search was conducted on November 2018 using three databases with the keyword combination (“functional approach” OR “functional method” OR “functional calibration”) AND (“hip joint” OR “knee joint” OR “ankle joint”) and analyzed by four reviewers. Given the existence of a recent review about the hip joint and the lack of material about the ankle joint, only papers about the knee joint were kept. The references cited in the selected papers were also screened in the final round of the search for these publications.

The quality of the selected papers was assessed and aspects regarding accuracy, repeatability, and feasibility were thoroughly considered to allow for a comparison between studies. Technical aspects, such as marker set choice, KJP determination techniques, demographics, and functional movements, were also included.

Results

Thirty-one papers were included and on average received a rating of about 75 % according to the quality scale used. The results showed that functional methods are superior or equivalent to predictive methods to estimate the KJA, while a regression method was slightly better for KJC prediction.

Significance

Calibration methods should be applied to CGA whenever feasibility is reached. No study to date has focused on evaluating the in vivo RoM required to obtain reliable and repeatable results and future work should aim in this direction.

中文翻译：

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专注于功能性膝盖参数的确定，以开发更好的临床步态分析方案

背景

自1990年代以来，尝试改进基于标记的临床步态分析（CGA）的协议标准一直是增强鲁棒性和可靠性结果的主要研究重点之一。确定关节中心和轴是这些协议的重要方面。尽管在此类研究中髋关节更为突出，但膝关节中心（KJC）和轴（KJA）直接影响所有结局。

研究问题

对CGA方案确定膝关节参数（KJP）的科学文献的研究提出了哪些建议？

方法

于2018年11月使用三个数据库进行了系统的电子搜索，这些数据库的关键词组合为``功能方法''或``功能方法''或``功能校准''和（``髋关节''或``膝关节''或``踝关节''）并由四位审稿人进行了分析。鉴于最近有关于髋关节的评论以及关于踝关节的材料不足，仅保留了有关膝关节的论文。在搜索这些出版物的最后一轮中，还筛选了所选论文中引用的参考文献。

评估所选论文的质量，并全面考虑准确性，可重复性和可行性方面，以便在研究之间进行比较。还包括标记集选择，KJP确定技术，人口统计和功能移动等技术方面。

结果

根据所使用的质量等级，共纳入31篇论文，平均获得约75％的评分。结果表明，功能方法优于或等同于预测方法来估计KJA，而回归方法对于KJC预测则稍好。

意义

只要可行，就应将校准方法应用于CGA。迄今为止，没有研究集中在评估获得可靠和可重复结果所需的体内RoM，未来的工作应朝这个方向发展。