Scholes Corey J, Lynch Joe T, Ebrahimi Milad, Fritsch Brett A, Parker David A
Sydney Orthopaedic Research Institute, Level 1, 445 Victoria Avenue, Chatswood, NSW, Australia.
Knee Surg Sports Traumatol Arthrosc. 2017 May;25(5):1489-1499. doi: 10.1007/s00167-016-4104-3. Epub 2016 Apr 16.
The biomechanical behaviour of the knee following multiple-ligament reconstruction (MLKR) may play a role in the pathogenesis of post-traumatic osteoarthritis. The aim of this study was to compare three-dimensional knee kinematics and gait characteristics of MLKR patients to healthy controls during level walking.
Three-dimensional optoelectronic motion capture during overground walking was performed on 16 patients with MLKR and a group of healthy controls matched individually to each patient for age, gender, height and weight. Three-dimensional knee angles were extracted from the weight acceptance and propulsion sub-phases of gait. Statistical analysis was performed using group-aggregated data, as well as for each patient-control pair using a single-case approach.
Although group analysis detected few differences, single-case analysis revealed significant differences for a proportion of patients for all dependent variables during weight acceptance and propulsion sub-phases of stance. These kinematic differences occurred in the context of reduced gait velocity, step length and cadence, as well as increased time spent in double support.
Patients with MLKR display abnormalities in knee kinematics during gait at an average of 4.5 years after surgery. The pattern of kinematic abnormalities appears individual specific and may not be related to differences in spatiotemporal gait characteristics. The current findings describe detailed functional outcomes of MLKR reconstruction at average medium-term follow-up that provide improved prognostic information for clinicians to counsel patients with these types of injuries.
多韧带重建（MLKR）术后膝关节的生物力学行为可能在创伤后骨关节炎的发病机制中起作用。本研究的目的是比较MLKR患者与健康对照者在平地行走时的三维膝关节运动学和步态特征。
对16例MLKR患者和一组与每位患者年龄、性别、身高和体重相匹配的健康对照者进行地面行走时的三维光电运动捕捉。从步态的负重和推进子阶段提取三维膝关节角度。使用分组汇总数据以及采用单病例方法对每对患者-对照进行统计分析。
尽管组间分析发现差异较少，但单病例分析显示，在站立的负重和推进子阶段，部分患者的所有因变量均存在显著差异。这些运动学差异出现在步态速度、步长和步频降低以及双支撑时间增加的情况下。
MLKR患者在术后平均4.5年的步态中膝关节运动学存在异常。运动学异常模式似乎具有个体特异性，可能与时空步态特征的差异无关。目前的研究结果描述了MLKR重建在平均中期随访时的详细功能结果，为临床医生为这类损伤患者提供咨询提供了更好的预后信息。
