Hart Harvi F, Collins Natalie J, Ackland David C, Cowan Sallie M, Crossley Kay M
1Department of Physiotherapy, University of Melbourne, Parkville, Victoria, AUSTRALIA; 2Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, AUSTRALIA; 3Physiotherapy Department, St. Vincent's Hospital, Melbourne, Victoria, AUSTRALIA; and 4School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, AUSTRALIA.
Med Sci Sports Exerc. 2015 Nov;47(11):2406-15. doi: 10.1249/MSS.0000000000000671.
Lateral knee osteoarthritis (OA) is common after anterior cruciate ligament reconstruction (ACLR), yet gait characteristics associated with lateral knee OA after ACLR are not well understood. This cross-sectional study aimed to compare knee, trunk, pelvis, hip, and ankle kinematics and moments between people with predominant lateral knee OA after ACLR and healthy controls.
Nineteen post-ACLR people with lateral knee OA and 25 healthy controls were recruited. Quantitative gait analysis was conducted during walking, and knee pain, confidence, and kinesiophobia were assessed. Between-group differences in peak kinematics and moments were evaluated, and Pearson correlations evaluated relations between biomechanical and patient-reported measures (P < 0.05).
Participants with lateral knee OA after ACLR had greater peak knee flexion (mean difference, 3.5°; 95% confidence interval, 0.9-6.1) and lower knee internal rotation angles (-3.3°; -6.2 to -0.5) than the controls. Those with lateral knee OA also had greater peak pelvic anterior tilt (3.1°, 0.4-5.9), hip flexion angles (5.1°, 1.9-8.3), and peak ankle dorsiflexion moment (0.1 N·m·kg(-1), 0.0-0.2). In the lateral knee OA group, worse knee confidence and kinesiophobia were significantly correlated with greater peak trunk flexion angle (r = 0.654 and r = 0.535, respectively) and greater knee pain was significantly correlated with greater peak knee flexion angle (r = 0.535).
Gait characteristics associated with lateral knee OA after ACLR differ from those in healthy individuals, predominantly in the sagittal plane. Increased sagittal plane knee and trunk kinematics seem to be related to worse knee pain, confidence, and kinesiophobia. These findings will assist the development of compartment-specific interventions for individuals with posttraumatic lateral knee OA.
前交叉韧带重建术（ACLR）后，膝关节外侧骨关节炎（OA）较为常见，但ACLR术后与膝关节外侧OA相关的步态特征尚未完全明确。本横断面研究旨在比较ACLR术后以膝关节外侧OA为主的患者与健康对照者在膝关节、躯干、骨盆、髋关节和踝关节的运动学及力矩情况。
招募了19名ACLR术后患有膝关节外侧OA的患者和25名健康对照者。在行走过程中进行定量步态分析，并评估膝关节疼痛、信心和运动恐惧。评估组间峰值运动学和力矩的差异，Pearson相关性分析评估生物力学指标与患者报告指标之间的关系（P<0.05）。
ACLR术后患有膝关节外侧OA的参与者与对照组相比，膝关节最大屈曲角度更大（平均差异为3.5°；95%置信区间为0.9 - 6.1），膝关节内旋角度更小（-3.3°；-6.2至-0.5）。患有膝关节外侧OA的患者还具有更大的骨盆前倾峰值（3.1°，0.4 - 5.9）、髋关节屈曲角度（5.1°，1.9 - 8.3）和踝关节背屈峰值力矩（0.1 N·m·kg-1，0.0 - 0.2）。在膝关节外侧OA组中，较差的膝关节信心和运动恐惧与更大的躯干屈曲峰值角度显著相关（分别为r = 0.654和r = 0.535），更严重的膝关节疼痛与更大的膝关节屈曲峰值角度显著相关（r = 0.535）。
ACLR术后与膝关节外侧OA相关的步态特征与健康个体不同，主要体现在矢状面上。矢状面膝关节和躯干运动学增加似乎与更严重的膝关节疼痛、信心和运动恐惧有关。这些发现将有助于为创伤后膝关节外侧OA患者制定特定关节的干预措施。
