The objectives of this study were to estimate pre- and postoperative lower limb kinematics and kinetics and knee intra-articular forces during gait using musculoskeletal modeling in a cohort of patients with knee osteoarthritis (OA) undergoing high tibial osteotomy (HTO), compare these to controls, and determine correlations between changes in these parameters and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores after HTO. Sixteen patients with isolated, symptomatic medial compartment knee OA completed pre- and postoperative gait analysis (mean follow-up time: 8.6 months). Sixteen age- and sex-matched asymptomatic volunteers participated as controls. Musculoskeletal modeling was used to evaluate lower limb joint moments and knee contact forces during gait. While HTO had limited influence on sagittal plane kinematics and moments, significant changes in the load distribution at the knee after HTO were observed with a lower postoperative compressive load on the medial compartment during midstance and a higher compressive load on the lateral compartment during early and late stance. Moreover, the lateral shear force in midstance was significantly lower after HTO. Changes in the external knee adduction moment (KAM) did not always coincide with reductions in the knee compressive force in the medial compartment. Biomechanical changes did not correlate with improvements in KOOS subscores. Hence, HTO effectively unloaded the medial compartment by redistributing part of the overall compressive force to the lateral compartment during gait with limited influence on gait function. The KAM may not adequately describe compartmental load magnitude or changes induced by interventions at the compartment level. Clinical trial registration: ClinicalTrials. gov Identifier—NCT02622204. Clinical significance: This study provides important evidence for changes in joint level loads after corrective osteotomy as joint preserving surgery and emphasizes the need for additional biomechanical outcomes of such interventions.

中文翻译：

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胫骨高位截骨术有效地重新分配步行期间的压缩膝关节负荷

本研究的目的是在一组接受胫骨高位截骨术 (HTO) 的膝骨关节炎 (OA) 患者中使用肌肉骨骼模型评估步态期间的术前和术后下肢运动学和动力学以及膝关节内力，并将这些与控制，并确定这些参数的变化与 HTO 后膝关节损伤和骨关节炎结果评分 (KOOS) 子评分之间的相关性。16 名孤立的、有症状的内侧间室膝关节 OA 患者完成了术前和术后步态分析（平均随访时间：8.6 个月）。16 名年龄和性别匹配的无症状志愿者作为对照参加。肌肉骨骼建模用于评估步态期间的下肢关节力矩和膝关节接触力。虽然 HTO 对矢状面运动学和力矩的影响有限，观察到 HTO 后膝关节负荷分布发生显着变化，术后站立中期内侧间室的压缩负荷较低，而早期和晚期站立时外侧间室的压缩负荷较高。此外，HTO 后中间的侧向剪切力显着降低。外膝关节内收力矩 (KAM) 的变化并不总是与膝关节内侧间室压缩力的降低一致。生物力学变化与 KOOS 分项分数的提高无关。因此，HTO 在步态期间通过将部分总压缩力重新分配到外侧间室来有效地卸载内侧间室，对步态功能的影响有限。KAM 可能无法充分描述隔间负载大小或隔间级别干预引起的变化。临床试验注册：ClinicalTrials。政府标识符——NCT02622204。临床意义：这项研究为矫正截骨术作为关节保留手术后关节水平负荷的变化提供了重要证据，并强调了此类干预措施需要额外的生物力学结果。