OBJECTIVE:Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross-sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA). METHODS:One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs). RESULTS:After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = -0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient -10.9 [95% CI -19.5, -2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient -16.8 [95% CI -28.9, -4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]). CONCLUSION:In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement.

译文

目的:尽管有证据表明增加股四头肌力量对膝关节症状有有益作用,但对膝关节结构的影响尚不清楚。我们进行了这项研究,以检查有症状膝骨关节炎(OA)患者的股内侧截面积(CSA)变化与膝关节疼痛,胫骨软骨体积和膝关节置换风险之间的关系。
方法:117名有症状膝骨关节炎的受试者在基线,2岁和4.5岁接受了膝部磁共振成像。在基线和第2年测量中侧股静脉CSA。在基线以及第2和4.5年测量胫骨软骨体积。在基线和第2年,通过西安大略和麦克马斯特大学的骨关节炎指数评估膝关节疼痛。确定了4年内膝关节置换的频率。确定回归系数(B)和比值比以及95%的置信区间(95%CI)。
结果:校正混杂因素后,基线膝关节内侧CSA与当前膝关节疼痛呈负相关(r = -0.16,P = 0.04),并且与基线至2年时胫骨软骨内侧体积损失呈负相关(B系数-10.9 [95%CI- 19.5,-2.3]),但不包括胫骨基线软骨体积。此外,从基线期到2年内,腓肠肌CSA的增加与同期膝关节疼痛的减轻有关(r = 0.24,P = 0.007),胫骨内侧软骨损失从2年减少到4.5年(B系数-16.8) [95%CI -28.9,-4.6]),并在4年内降低了膝关节置换的风险(赔率0.61 [95%CI 0.40,0.94])。
结论:在有症状的膝骨关节炎患者中,股骨内侧vast增大与膝关节疼痛减轻和膝部有益的结构变化有关,这表明管理膝痛和优化股骨内侧media肌对于减少OA进展和随后的膝关节起重要作用。替代品。

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