Asaeda Makoto, Deie Masataka, Fujita Naoto, Shimada Noboru, Orita Naoya, Iwaki Daisuke, Kono Yoshifumi, Terai Chiaki, Ochi Mitsuo
Health Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Musculoskeletal Functional Research and Regeneration, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3254-3261. doi: 10.1007/s00167-016-4040-2. Epub 2016 Feb 11.
Gait kinematics and kinetics of the knee before and after medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent lateral patellar dislocation (RPD) are unknown. The purpose of this study was to measure knee kinematics and kinetics during gait before and 1 year after anatomical MPFL reconstruction in patients with RPD and compare the results to healthy individuals.
Eleven RPD patients were treated using an anatomical MPFL reconstruction procedure. Gait analysis was conducted before and at 3, 6, and 12 months after surgery. For comparison, 15 healthy volunteers with no history of orthopaedic problems in their lower limbs were included as the control group. Knee kinematics and kinetics were analysed during gait.
Before surgery, the internal knee extension moment in RPD patients was significantly lower than in controls (P = 0.025). At 3 months post-operatively, there was an additional decrease in knee extension moment compared to before surgery, and so it was still significantly lower than in the control group (P < 0.01). One year post-operatively, knee extension moment in the RPD group was significantly increased compared to 3 months post-operatively (P < 0.01). The knee flexion angle in the early stance phase in the RPD group at 3 months post-operatively was significantly lower than that of controls (P < 0.01). Knee kinematics and kinetics were similar to that of controls 1 year after surgery.
Initially, RPD patients had lower knee extension moments during gait compared with controls, but by 1 year after MPFL reconstruction, knee kinematics and kinetics of gait in the RPD patients had returned to normal. These observations indicate that MPFL reconstruction may help to delay prospective knee OA as long as possible by restoring the conformation of the patellofemoral joint and gait biomechanics by surgery.
复发性髌骨外侧脱位（RPD）患者内侧髌股韧带（MPFL）重建前后膝关节的步态运动学和动力学尚不清楚。本研究的目的是测量RPD患者在解剖学MPFL重建术前和术后1年的步态中膝关节的运动学和动力学，并将结果与健康个体进行比较。
11例RPD患者采用解剖学MPFL重建手术治疗。在手术前以及术后3、6和12个月进行步态分析。作为对照组，纳入15名无下肢骨科问题病史的健康志愿者。在步态期间分析膝关节的运动学和动力学。
手术前，RPD患者的膝关节内伸力矩显著低于对照组（P = 0.025）。术后3个月，与手术前相比膝关节伸力矩进一步下降，因此仍显著低于对照组（P < 0.01）。术后1年，RPD组的膝关节伸力矩与术后3个月相比显著增加（P < 0.01）。术后3个月时，RPD组在早期站立相的膝关节屈曲角度显著低于对照组（P < 0.01）。术后1年膝关节的运动学和动力学与对照组相似。
最初，RPD患者在步态中的膝关节伸力矩低于对照组，但在MPFL重建术后1年，RPD患者步态的膝关节运动学和动力学已恢复正常。这些观察结果表明，MPFL重建可能通过手术恢复髌股关节的形态和步态生物力学，从而有助于尽可能长时间地延缓预期的膝关节骨关节炎。
