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“独眼巨人”损伤与前交叉韧带重建术后1年步态模式改变及膝关节内侧软骨退变有关。

Cyclops lesions are associated with altered gait patterns and medial knee joint cartilage degeneration at 1 year after ACL-reconstruction.

作者信息

Samaan Michael A, Facchetti Luca, Pedoia Valentina, Tanaka Matthew S, Link Thomas M, Souza Richard B, Ma C Benjamin, Li Xiaojuan

机构信息

Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, California 94107.

Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, California.

出版信息

J Orthop Res. 2017 Oct;35(10):2275-2281. doi: 10.1002/jor.23530. Epub 2017 Feb 10.

Abstract

In this exploratory study, gait analysis and quantitative MRI (QMRI) were used to assess biomechanical differences in patients that present with cyclops lesions at 12 months after ACL-reconstruction (ACLR). Thirty ACLR patients without and 10 ACLR patients with cyclops lesions underwent 3T MR T mapping of the reconstructed knee joint prior to ACLR and at 12 months after ACLR, as well as a gait assessment during a fixed walking speed at 12 months after ACLR. Both external sagittal and frontal plane knee joint moments and joint moment impulses were calculated and assessed throughout the stance phase of gait. ACLR patients with cyclops lesions demonstrated a significantly greater (34% larger, p = 0.03) first peak knee flexion moment (KFM) and KFM impulse (42% larger, p = 0.05), compared to those without cyclops lesions, which may suggest an increased load during the loading response phase of gait. There were no differences (p > 0.05) in knee extension or adduction joint moments or moment impulses. ACLR patients with cyclops lesions demonstrated a significantly increased change in T (ΔT  = 4.7 ms, p = 0.03), over 12 months, within the central medial tibia. The results of the study suggest that ACLR patients with cyclops lesions demonstrate altered sagittal plane loading patterns which may be related to an increased rate of medial tibiofemoral cartilage degeneration at 12 months after ACLR. The first peak external KFM may be an important target for intervention programs in ACLR patients with cyclops lesions in order to possibly slow the onset or progression of medial tibiofemoral cartilage degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2275-2281, 2017.

摘要

在这项探索性研究中,步态分析和定量磁共振成像(QMRI)被用于评估前交叉韧带重建术(ACLR)后12个月出现独眼巨人病变的患者的生物力学差异。30例无独眼巨人病变的ACLR患者和10例有独眼巨人病变的ACLR患者在ACLR术前和术后12个月接受了重建膝关节的3T磁共振T成像,以及在ACLR术后12个月以固定步行速度进行的步态评估。在整个步态站立期计算并评估了矢状面和额状面的膝关节力矩和关节力矩冲量。与没有独眼巨人病变的患者相比,有独眼巨人病变的ACLR患者表现出明显更大(大34%,p = 0.03)的首次峰值屈膝力矩(KFM)和KFM冲量(大42%,p = 0.05),这可能表明在步态的负重反应阶段负荷增加。膝关节伸展或内收关节力矩或力矩冲量没有差异(p > 0.05)。有独眼巨人病变的ACLR患者在12个月内胫骨中部内侧的T值变化显著增加(ΔT = 4.7毫秒,p = 0.03)。研究结果表明,有独眼巨人病变的ACLR患者表现出矢状面负荷模式改变,这可能与ACLR术后12个月胫股内侧软骨退变率增加有关。首次峰值外部KFM可能是针对有独眼巨人病变的ACLR患者干预方案的一个重要靶点,以便可能减缓胫股内侧软骨退变的发生或进展。©2017骨科研究协会。由威利期刊公司出版。《矫形外科学研究》35:2275 - 2281,2017。

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