内侧膝关节骨关节炎患者同期行胫骨高位截骨术和前交叉韧带重建术后步态生物力学的五年变化

Five-year changes in gait biomechanics after concomitant high tibial osteotomy and ACL reconstruction in patients with medial knee osteoarthritis.

作者信息

Marriott Kendal, Birmingham Trevor B, Kean Crystal O, Hui Catherine, Jenkyn Thomas R, Giffin J Robert

机构信息

Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.

出版信息

Am J Sports Med. 2015 Sep;43(9):2277-85. doi: 10.1177/0363546515591995. Epub 2015 Aug 11.

DOI:10.1177/0363546515591995

PMID:26264767

Abstract

BACKGROUND

Concomitant high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction is a combined surgical procedure intended to improve kinematics and kinetics in the unstable ACL-deficient knee with varus malalignment and medial compartment knee osteoarthritis (OA).

PURPOSE

To investigate 5-year changes in gait biomechanics as well as radiographic and patient-reported outcomes bilaterally after unilateral, concomitant medial opening wedge HTO and ACL reconstruction.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 33 patients (mean ± SD age, 40 ± 9 years) with varus malalignment (mean mechanical axis angle, -5.9° ± 2.9°), medial compartment knee OA, and ACL deficiency completed 3-dimensional gait analysis preoperatively and 2 and 5 years postoperatively. Primary outcomes were the peak external knee adduction (first peak) and flexion moments. Secondary outcomes were the peak external knee extension and transverse plane moments, peak knee angles in all 3 planes, radiographic static knee alignment measures (mechanical axis angle and posterior tibial slope), and the Knee injury and Osteoarthritis Outcome Score (KOOS).

RESULTS

There was a substantial decrease in the knee adduction moment in the surgical limb (%BW × H, -1.49; 95% CI, -1.75 to -1.22) and a slight increase in the nonsurgical limb (%BW × H, 0.16; 95% CI, 0.03 to 0.30) from preoperatively to 5 years postoperatively. There was also a decrease in the knee flexion moment for both the surgical (%BW × H, -0.67; 95% CI, -1.19 to -0.15) and nonsurgical limbs (%BW × H, -1.06; 95% CI, -1.49 to -0.64). Secondary outcomes suggested that substantial improvements were maintained at 5 years, although smaller declines were observed in several measures and in both limbs from 2 to 5 years.

CONCLUSION

Changes in the peak external moments about the knee in all 3 planes during walking were observed 5 years after concomitant medial opening wedge HTO and ACL reconstruction. These findings are consistent with an intended, sustained shift in the mediolateral distribution of knee loads.

CLINICAL RELEVANCE

These findings suggest that concomitant HTO and ACL reconstruction results in substantial changes in gait biomechanics. Future clinical research comparing treatment strategies is both warranted and required for this relatively uncommon but seemingly biomechanically efficacious procedure.

摘要

背景

胫骨高位截骨术（HTO）与前交叉韧带（ACL）重建术同期进行，是一种联合手术，旨在改善存在内翻畸形和内侧间室膝骨关节炎（OA）的ACL损伤不稳定膝关节的运动学和动力学。

目的

研究单侧同期内侧开放楔形HTO与ACL重建术后5年双侧步态生物力学、影像学及患者报告结局的变化。

研究设计

对照实验室研究。

方法

共有33例内翻畸形（平均机械轴角，-5.9°±2.9°）、内侧间室膝OA及ACL损伤的患者（平均年龄±标准差，40±9岁）在术前、术后2年和5年完成了三维步态分析。主要结局指标为膝关节最大外展（第一个峰值）和屈曲力矩。次要结局指标为膝关节最大伸展和横断面力矩、三个平面内的最大膝关节角度、影像学静态膝关节对线测量指标（机械轴角和胫骨后倾角）以及膝关节损伤和骨关节炎结局评分（KOOS）。

结果

从术前到术后5年，手术侧膝关节内收力矩大幅下降（%体重×身高，-1.49；95%可信区间，-1.75至-1.22），非手术侧略有增加（%体重×身高，0.16；95%可信区间，0.03至0.30）。手术侧（%体重×身高，-0.67；95%可信区间，-1.19至-0.15）和非手术侧（%体重×身高，-1.06；95%可信区间，-1.49至-0.64）的膝关节屈曲力矩也有所下降。次要结局指标表明，5年时仍保持显著改善，尽管从2年到5年，几个测量指标及双侧均出现了较小幅度的下降。