Bohnsack Michael, Halcour Andre, Klages Phillip, Wilharm Arne, Ostermeier Sven, Rühmann Oliver, Hurschler Christof
Department of Orthopaedic Surgery, Hannover Medical School, Anna-Von-Borries-Str. 1-7, 30625, Hannover, Germany.
Knee Surg Sports Traumatol Arthrosc. 2008 Feb;16(2):135-41. doi: 10.1007/s00167-007-0428-3. Epub 2007 Nov 14.
The aim of this study was to analyze the biomechanical consequences of patella bracing in order to evaluate possible mechanisms supporting its clinical application. The hypothesis is that the patellar bracing reduces patellofemoral pressure by influencing patellar and knee kinematics, and load distribution. Physiologic isokinetic knee extension motions were simulated on ten human knee cadaver specimens using a knee kinematic simulator. Joint kinematics were evaluated using an ultrasound-based motion analysis system and patellofemoral contact pressure was measured using a thin-film piezoresistive pressure measuring system. Infrapatellar tissue pressure was analyzed using a closed sensor-cell. Three different patella braces were fitted to the knee cadavers and their influence on the kinematic and kinetic biomechanical parameters were evaluated and compared to the physiologic situation. Patellar bracing resulted in a significant (p = 0.05) proximalization of the patella up to 3 mm. Depending on the type of brace used, a decrease in the infrapatellar fat pad pressure was found and the patellofemoral contact area was decreased significantly (p = 0.05) between 60 degrees of knee flexion and full extension (maximum 22%). Patella bracing significantly (p = 0.05) reduced the patellofemoral contact pressure an average of 10%, as well as the peak contact pressure which occurred. Patellar bracing significantly influences patella biomechanics in a reduction of the patellofemoral contact area and contact pressure as well as a decrease in the infrapatellar tissue pressure. The application of infrapatellar straps is suggested for the treatment and prevention of anterior knee pain, especially in high level sports.
本研究的目的是分析髌骨支具的生物力学后果，以评估支持其临床应用的可能机制。假设是髌骨支具通过影响髌骨和膝关节运动学以及负荷分布来降低髌股压力。使用膝关节运动模拟器在十个新鲜人体膝关节标本上模拟生理性等速膝关节伸展运动。使用基于超声的运动分析系统评估关节运动学，并使用薄膜压阻式压力测量系统测量髌股接触压力。使用封闭的传感单元分析髌下组织压力。将三种不同的髌骨支具安装在膝关节标本上，评估它们对运动学和动力学生物力学参数的影响，并与生理状态进行比较。髌骨支具导致髌骨明显（p = 0.05）向近端移位达3毫米。根据所使用的支具类型，发现髌下脂肪垫压力降低，并且在膝关节屈曲60度至完全伸展之间，髌股接触面积显著减小（p = 0.05）（最大22%）。髌骨支具显著（p = 0.05）降低了髌股接触压力，平均降低了10%，以及降低了出现的峰值接触压力。髌骨支具显著影响髌骨生物力学，减少了髌股接触面积和接触压力，并降低了髌下组织压力。建议使用髌下束带来治疗和预防膝前疼痛，尤其是在高水平运动中。
