前交叉韧带重建参与者与对照组参与者在正常行走和斜坡行走时的膝关节力矩。

Knee moments of anterior cruciate ligament reconstructed and control participants during normal and inclined walking.

作者信息

Varma Raghav K, Duffell Lynsey D, Nathwani Dinesh, McGregor Alison H

机构信息

MSK Lab, Imperial College London, London, UK.

出版信息

BMJ Open. 2014 Jun 4;4(6):e004753. doi: 10.1136/bmjopen-2013-004753.

DOI:10.1136/bmjopen-2013-004753

PMID:24898088

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4054639/

Abstract

OBJECTIVES

Prior injury to the knee, particularly anterior cruciate ligament (ACL) injury, is known to predispose one to premature osteoarthritis (OA). The study sought to explore if there was a biomechanical rationale for this process by investigating changes in external knee moments between people with a history of ACL injury and uninjured participants during walking: (1) on different surface inclines and (2) at different speeds. In addition we assessed functional differences between the groups.

PARTICIPANTS

12 participants who had undergone ACL reconstruction (ACLR) and 12 volunteers with no history of knee trauma or injury were recruited into this study. Peak knee flexion and adduction moments were assessed during flat (normal and slow speed), uphill and downhill walking using an inclined walkway with an embedded Kistler Force plate, and a ten-camera Vicon motion capture system. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to assess function. Multivariate analysis of variance (MANOVA) was used to examine statistical differences in gait and KOOS outcomes.

RESULTS

No significant difference was observed in the peak knee adduction moment between ACLR and control participants, however, in further analysis, MANOVA revealed that ACLR participants with an additional meniscal tear or collateral ligament damage (7 participants) had a significantly higher adduction moment (0.33±0.12 Nm/kg m) when compared with those with isolated ACLR (5 participants, 0.1±0.057 Nm/kg m) during gait at their normal speed (p<0.05). A similar (non-significant) trend was seen during slow, uphill and downhill gait.

CONCLUSIONS

Participants with an isolated ACLR had a reduced adductor moment rather an increased moment, thus questioning prior theories on OA development. In contrast, those participants who had sustained associated trauma to other key knee structures were observed to have an increased adduction moment. Additional injury concurrent with an ACL rupture may lead to a higher predisposition to osteoarthritis than isolated ACL deficiency alone.

摘要

目的

已知膝关节既往损伤，尤其是前交叉韧带（ACL）损伤，会使人易患早发性骨关节炎（OA）。本研究旨在通过调查ACL损伤史患者与未受伤参与者在行走过程中膝关节外部力矩的变化，探索这一过程是否存在生物力学原理：（1）在不同的表面坡度下；（2）以不同的速度。此外，我们评估了两组之间的功能差异。

参与者

本研究招募了12名接受过ACL重建术（ACLR）的参与者和12名无膝关节创伤或损伤史的志愿者。使用带有内置奇石乐测力板的倾斜走道和十台摄像机的Vicon运动捕捉系统，在平坦（正常速度和慢速）、上坡和下坡行走过程中评估膝关节屈曲和内收力矩峰值。使用膝关节损伤和骨关节炎疗效评分（KOOS）评估功能。采用多变量方差分析（MANOVA）来检验步态和KOOS结果的统计学差异。

结果

ACLR参与者与对照组参与者在膝关节内收力矩峰值上未观察到显著差异，然而，在进一步分析中，MANOVA显示，在正常速度步态期间，伴有半月板撕裂或侧副韧带损伤的ACLR参与者（7名参与者）的内收力矩（0.33±0.12 Nm/kg m）显著高于单纯ACLR参与者（5名参与者，0.1±0.057 Nm/kg m）（p<0.05）。在慢速、上坡和下坡步态期间也观察到类似（不显著）的趋势。