前交叉韧带损伤后早期膝关节骨关节炎相关的膝关节负荷降低
Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury.
作者信息
Wellsandt Elizabeth, Gardinier Emily S, Manal Kurt, Axe Michael J, Buchanan Thomas S, Snyder-Mackler Lynn
机构信息
University of Delaware, Newark, Delaware, USA
University of Michigan, Ann Arbor, Michigan, USA.
出版信息
Am J Sports Med. 2016 Jan;44(1):143-51. doi: 10.1177/0363546515608475. Epub 2015 Oct 22.
BACKGROUND
Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown.
HYPOTHESIS
Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction.
STUDY DESIGN
Case-control study; Level of evidence, 3.
METHODS
Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA.
RESULTS
Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs -0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: -0.001 ± 0.032 N·m·s/kg·m [nonOA] vs -0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs -0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036).
CONCLUSION
Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction.
背景
前交叉韧带（ACL）损伤使个体易患早发性膝关节骨关节炎（OA）。ACL损伤和重建后关节负荷异常明显。关节生物力学改变与膝关节OA发展之间的关系尚不清楚。
假设
损伤和重建后最初的膝关节动力学改变和内侧间室接触力与重建后5年的膝关节OA影像学表现相关。
研究设计
病例对照研究；证据等级，3级。
方法
急性单侧ACL损伤患者在术前康复前（基线）和后（训练后）以及重建后6个月、1年和2年完成步态分析。表面肌电图和膝关节生物力学数据作为输入，用于肌电图驱动的肌肉骨骼模型，以估计膝关节接触力。患者在重建后5年完成影像学检查。比较有和没有膝关节OA影像学表现的患者之间膝关节动力学和接触力的差异。
结果
在基线时，患OA的患者比未患OA的患者（非OA）在额状面的双侧肢体差异更大（膝关节内收力矩峰值差异：0.00±0.08N·m/kg·m[非OA]对-0.15±0.09N·m/kg·m[OA]，P = 0.014；膝关节内收力矩冲量峰值差异：-0.001±0.032N·m·s/kg·m[非OA]对-0.048±0.031N·m·s/kg·m[OA]，P = 0.042）。骨关节炎组患侧肢体的膝关节内收力矩冲量在基线时也低于非骨关节炎组（0.087±0.023N·m·s/kg·m[非OA]对0.049±0.018N·m·s/kg·m[OA]，P = 0.023）。训练后两组间无显著差异，但在重建后6个月再次出现差异（膝关节内收力矩峰值差异：0.02±0.04N·m/kg·m[非OA]对-0.06±0.11N·m/kg·m[OA]，P = 0.043）。此外，在6个月时，OA组患侧肢体的内侧间室峰值接触力低于非OA组（2.89±0.52体重[非OA]对2.10±0.69体重[OA]，P = 0.036）。
结论
ACL重建后5年有膝关节OA影像学表现的患者，与损伤和重建后早期未患OA的患者相比，行走时膝关节内收力矩和内侧间室关节接触力更低。
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