Gokeler Alli, Schmalz Thomas, Knopf Elmar, Freiwald Jürgen, Blumentritt Siegmar
Athletikum Sports Medicine Center, Hofheim, Germany.
Knee Surg Sports Traumatol Arthrosc. 2003 Nov;11(6):372-8. doi: 10.1007/s00167-003-0432-1. Epub 2003 Oct 3.
Gait alterations after ACL reconstruction have been reported in the literature. The current study examined a group of 14 patients who all had an ACL reconstruction with a patellar tendon autograft. Kinetic and kinematic data were obtained from the knee during walking. The flexion-extension deficit (FED) calculated from the angular difference between maximal flexion and maximal extension during the stance phase in the ACL-reconstructed and the normal knee was measured. We investigated whether these alterations in gait are related to quadriceps strength and residual laxity of the knee. It may be that patients modify their gait patterns to protect the knee from excessive anterior translation of the tibia by reducing the amount of extension during stance. On the other hand, persistent quadriceps weakness may also cause changes in gait patterns as the quadriceps is functioning as an important dynamic stabilizer of the knee during stance. Results showed that patients had a significantly higher FED value (4.9+/-4.0) than a healthy control group in a previous study (1.3+/-0.9). This is caused mainly by an extension deficit during midstance. External extension moments of the knee (TZMAX were significantly lower in the current patients group than in a healthy control group (TZMAX -0.27+/-0.19 Nm/kg in patients vs. -0.08+/-0.06 Nm/kg in controls). There were no significant correlations between quadriceps strength and gait analysis parameters. Furthermore no correlation was found between the amount of laxity of the knee and gait. The relevance of this study lies in the fact that apparently the measured gait alterations cannot be explained solely by often used biomechanical indicators such as laxity and strength. The measured gait alterations may be a result of the surgical procedure with subsequent modified motor programming.
文献中已有关于前交叉韧带重建术后步态改变的报道。本研究对一组14例均采用髌腱自体移植进行前交叉韧带重建的患者进行了检查。在步行过程中获取了膝关节的动力学和运动学数据。测量了根据前交叉韧带重建膝关节和正常膝关节在站立相期间最大屈曲和最大伸展之间的角度差计算得出的屈伸 deficit（FED）。我们研究了这些步态改变是否与股四头肌力量和膝关节残余松弛度有关。可能是患者通过减少站立时的伸展量来改变其步态模式，以保护膝关节免受胫骨过度向前平移的影响。另一方面，持续的股四头肌无力也可能导致步态模式的改变，因为股四头肌在站立时是膝关节重要的动态稳定器。结果显示，与先前研究中的健康对照组（1.3±0.9）相比，患者的FED值（4.9±4.0）显著更高。这主要是由站立中期的伸展 deficit 引起的。本患者组膝关节的外部伸展力矩（TZMAX）明显低于健康对照组（患者组TZMAX为-0.27±0.19 Nm/kg，对照组为-0.08±0.06 Nm/kg）。股四头肌力量与步态分析参数之间无显著相关性。此外，未发现膝关节松弛量与步态之间存在相关性。本研究的意义在于，显然所测量的步态改变不能仅由诸如松弛度和力量等常用的生物力学指标来解释。所测量的步态改变可能是手术操作及随后修改的运动程序的结果。
