Kean Crystal O, Birmingham Trevor B, Garland Jayne S, Jenkyn Thomas R, Ivanova Tanya D, Jones Ian C, Giffin Robert J
Wolf Orthopaedic Biomechanics Laboratory, University of Western Ontario, London, Ontario, Canada.
Med Sci Sports Exerc. 2009 Mar;41(3):612-9. doi: 10.1249/MSS.0b013e31818a8c91.
To evaluate the effects of simultaneous high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction on 1) the external knee adduction moment, 2) the external knee flexion and extension moments, and 3) the quadriceps, hamstrings, and gastrocnemius muscle activity during walking.
Twenty-one patients with varus malalignment of the lower limb, medial compartment knee osteoarthritis, and concomitant anterior cruciate ligament (ACL) deficiency were tested before and 1 yr after undergoing simultaneous medial opening wedge high tibial osteotomy (HTO) and ACL reconstruction during a single operation. Three-dimensional kinetic and kinematic data were used to calculate external coronal and sagittal moments about the knee. EMG data from the quadriceps, hamstrings, and gastrocnemius were used to determine coactivation ratio and activation patterns.
Neutral alignment and knee stability were achieved in all patients after surgery. The peak knee adduction moment decreased from 2.88 +/- 0.57 to 1.71 +/- 0.56%BW x Ht (P < 0.001). The early stance knee flexion moment decreased from 1.95 +/- 1.89 to 0.88 +/- 1.17%BW x Ht (P < 0.01). The late stance knee extension moment increased from 1.83 +/- 1.53 to 2.76 +/- 1.22%BW x Ht (P < 0.001). There were no significant differences in muscle coactivation or muscle activation patterns (P > 0.05).
Improving lower limb alignment and knee stability significantly alters the coronal and the sagittal moments about the knee during walking, without apparent changes in muscle activation patterns.
评估同期高位胫骨截骨术（HTO）和前交叉韧带（ACL）重建对以下方面的影响：1）膝关节外展力矩；2）膝关节屈伸力矩；3）行走过程中股四头肌、腘绳肌和腓肠肌的肌肉活动。
对21例下肢内翻畸形、膝关节内侧间室骨关节炎并伴有前交叉韧带（ACL）损伤的患者，在单次手术中同期行内侧张开楔形高位胫骨截骨术（HTO）和ACL重建术前及术后1年进行测试。利用三维动力学和运动学数据计算膝关节在冠状面和矢状面的外力矩。通过股四头肌、腘绳肌和腓肠肌的肌电图数据确定共激活率和激活模式。
术后所有患者均实现了下肢力线中立和膝关节稳定。膝关节内收力矩峰值从2.88±0.57降至1.71±0.56%BW×Ht（P<0.001）。早期站立期膝关节屈曲力矩从1.95±1.89降至0.88±1.17%BW×Ht（P<0.01）。晚期站立期膝关节伸展力矩从1.83±1.53增至2.76±1.22%BW×Ht（P<0.001）。肌肉共激活或肌肉激活模式无显著差异（P>0.05）。
改善下肢力线和膝关节稳定性可显著改变行走过程中膝关节在冠状面和矢状面的力矩，而肌肉激活模式无明显变化。
