| BackgroundKnee osteoarthritis(KOA)is one of the most common musculoskeletal diseases of the lower limb,and it occurs more in elderly female.The causes of KOA are diverse and indefinite.In recent years,many studies have shown that the occurrence and progress of KOA is closely related to the structure of the foot.When the foot experienced postural or structural changes,such as pronated feet,supinated feet,flat feet,hallux valgus(HV),etc.,it would cause corresponding subsequence in the alignment of ankle and knee joint.HV is a common foot disease in elderly female and is the leading cause of foot pain and deformity.HV may affect the ankle and knee joints due to changes on its own structure and biomechanics.Previous studies have mainly observed the changes in gait and plantar pressure caused by the structure of the foot to explore its effect on the knee joint,and research on the relationship between related muscle’s elasticity measurement and knee function is absentObjectivesIn this study,we focus on the changes of elastic modulus of tibialis anterior muscle(TA)and peroneus longus muscle(PL)in KOA patients with or without HV,combining with X-ray,pain assessment,hallux valgus angle(HVA),medial arch vertex angle and anterior arch angle,to explore the relationship between the elasticity of TA and PL and the occurrence of HV and KOA.MethodsForty-seven KOA patients(Among them,27 cases were unilateral KOA patients and 20 cases were bilateral KOA patients)who were admitted to the department of pain in Jinan Central Hospital from July 2019 to December 2019 were included in this case-control study.A single affected limb was considered as a sample,so the total number of affected limbs was 67.The inclusion criteria were female KOA patients aged 60-80 years,the affected limbs with or without HV,excluding the history of knee and foot surgery,inflammatory arthritis,neurological disease,lower extremity venous disease and the presence of psychological problem.According to the affected limbs with or without HV,patients were divided into two groups:HV+KOA group and KOA group.HV+KOA group contained 31 affected limbs(11 cases were unilateral affected patients and 10 cases were bilateral affected patients)and KOA group contained 36 affected limbs(16 cases were unilateral affected patients and 10 cases were bilateral affected patients).We also enrolled 15 healthy women aged 20-30 years except from the history of knee pain,lower extremity disease and surgery as healthy control group.The X-ray examination of the affected knee joint and affected foot was performed.Simultaneously,we record age,body mass index(BMI),visual analogue scale(VAS)score of knee,knee pain duration,course of KOA and HV,HVA,medial arch vertex angle and anterior arch angle.SWE technology was used to measure the elastic modulus of TA and PL under relaxed and maximum voluntary isometric contraction(MVIC)states in supine position with knee extension,including affected limbs of KOA patients and both sides in healthy control group.SPSS23.0 software was used for statistical analysis of the measurement data.Measurement data were calculated as mean±standard deviation,and categorical variables were expressed as number of cases and percentage.For comparison of variables between groups,independent-samples t-test was used.Paired-samples t-test was performed to compare the paired variables within groups.Pearson correlation analysis was used to check the correlationship between the variables.Any P-values<0.05 were considered to be statistically significant.Results1.General informationThe basic data such as age,BMI,knee pain duration,and course of KOA did not significantly differ between HV+KOA group and KOA group(P>0.05).In HV+KOA group,the knee pain duration of bilateral affected patients was significantly higher than unilateral affected patients(18.00±5.48min vs.13.64±5.52min,P<0.05);course of KOA and HV,HVA,medial arch vertex angle and anterior arch angle were not significantly different between bilateral affected and unilateral affected patients(P>0.05).2.VAS scoresHV+KOA group was significantly more likely to have higher knee VAS scores compared with KOA group(7.89±0.75cm vs.7.40±0.95cm,P<0.05).Unilateral affected patients in the HV+KOA group had no significant difference in VAS scores(7.31 ± 0.79cm)compared with unilateral affected patients in KOA group(6.88±1.03cm)(P>0.05).The VAS scores of bilateral affected patients in HV+KOA group(8.21 ± 0.50cm)were significantly higher than bilateral affected patients in KOA group(7.82±0.63cm)(P<0.05).In HV+KOA and KOA groups,the VAS scores of bilateral affected patients were significantly higher than unilateral affected patients(P<0.05).3.Elastic modulus of TA and PLElastic modulus of TA under relaxed state in supine position with knee extension were not significantly different among HV+KOA group,KOA group and healthy control group(P>0.05).Patients in HV+KOA group had significantly higher elastic modulus of TA(198.71±22.68kPa)under MVIC state in supine position with knee extension compared with KOA group(166.46±26.65kPa)and healthy control group(162.61±41.20kPa)(P<0.05),and the values were not significantly different between HV+KOA group and KOA group(P>0.05).HV+KOA group was significantly more likely to have higher elastic modulus differences of TA before and after MVIC compared with KOA group(167.74±19.68kPa vs.137.48±27.90kPa,P<0.05).In HV+KOA and KOA groups,elastic modulus of TA under MVIC state in bilateral affected patients(HV+KOA group:206.85±19.83kPa,KOA group:180.33±21.35kPa)were significantly higher compared with unilateral affected patients(HV+KOA group:183.90±20.55kPa,KOA group:149.12±22.42kPa)(P<0.05).Elastic modulus of PL under relaxed state in supine position with knee extension were not significantly different between HV+KOA group,KOA group and healthy control group(P>0.05).Patients in healthy control group had significantly higher elastic modulus of PL(147.32±27.77kPa)under MVIC state in supine position with knee extension compared with HV+KOA group(115.41 ± 12.07kPa)and KOA group(124.20±13.27kPa)(P<0.05),and the values in KOA group were significantly higher than HV+KOA group(P<0.05).KOA group was significantly more likely to have higher elastic modulus differences of PL before and after MVIC compared with HV+KOA group(88.10±10.96kPa vs.9 7.03±11.58kPa;P<0.05).4.Correlation analysis in HV+KOA groupIn HV+KOA group,the elastic modulus differences of TA before and after MVIC had significantly positive correlation with the knee VAS scores of ipsilateral limb(r=0.854,P<0.05),HVA(r=0.787,P<0.05),medial arch vertex angle(r=0.525,P<0.05),and were negatively associated with anterior arch angle(r=-0.570,P<0.05).The elastic modulus differences of PL before and after MVIC were positively correlated with the differences of TA(r=0.500,P<0.05)and medial arch angle(r=0.396,P<0.05),and negatively correlated with anterior arch angle(r=-0.382,P<0.05).Conclusion1.In elderly female patients with KOA,patients with ipsilateral HV suffer more severe knee pain than those without HV,and bilateral affected patients experience more severe knee pain than unilateral affected patients.2.In elderly female patients with KOA,the elasticity of PL at MVIC state is lower than that of healthy people,and the elasticity of PL at MVIC state is lower in patients with ipsilateral HV than patients without HV.The elderly female KOA patients with ipsilateral HV have significantly higher TA elasticity at MVIC than healthy people,while patients without HV have no significant difference in TA elasticity from healthy people.Patients with bilateral affected KOA are more likely to have higher elasticity of TA under MVIC state than unilateral affected patients.3.In elderly female KOA patients,there are significant associations between the changes of TA elasticity,the degree of knee pain,the severity of HV and the degree of the medial longitudinal arch descent,and the changes of PL elasticity has significantly correlation with the changes of TA elasticity and the degree of the medial longitudinal arch descent. |
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