Branch Thomas P, Stinton Shaun K, Hutton William C, Neyret Philippe
University Orthopedics, Decatur, GA, USA.
ArthroMetrix LLC, 441 Armour Place NE, Atlanta, GA, 30324, USA.
Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1038-1047. doi: 10.1007/s00167-017-4497-7. Epub 2017 Mar 15.
The purpose of this study was to identify biomechanical factors, in both reconstructed and healthy knees, that correlate with patient satisfaction after ACL reconstruction.
Seventeen patients who had undergone unilateral ACL reconstruction were reviewed 9 years post-op. Patients completed subjective questionnaires and underwent manual knee laxity testing (Lachman-Trillat, KT-1000, and pivot shift) and automated laxity testing. During automated testing, both legs were rotated into external rotation and then internal rotation until peak rotational torque reached 5.65 Nm. Load-deformation curves were generated from torque and rotation data. Features of the curves were extracted for analysis. Total leg rotation and anterior laxity during KT-1000 testing were combined into a single factor (Joint Play Envelope or JPE). Patients were divided into groups based on patient satisfaction scores (Group 1: Higher Satisfaction, Group 2: Lower Satisfaction, Group 3: Unsatisfied). Load-deformation curve features and manual laxity testing results were compared between groups 1 and 2 to determine which biomechanical factors could distinguish between the groups. Diagnostic screening values were calculated for KT-1000 testing, the pivot shift test, total leg rotation and JPE.
During manual testing, no significant differences in biomechanical factors were found when comparing reconstructed knees in group 1 and group 2. When comparing the reconstructed and healthy knees within group 2, the reconstructed knees had a significantly higher displacement during the KT-1000 manual maximum test (p < 0.002). When considering the reconstructed knees alone, neither the result of the pivot shift test nor KT-1000 testing could distinguish between group 1 and group 2. During automated testing, there were no significant differences between the groups when comparing the reconstructed lower limbs. The healthy lower limbs in group 2 had more maximum external rotation (p < 0.02) and decreased stiffness at maximum external rotation (p < 0.02) when compared to the healthy lower limbs in group 1. Total leg rotation was unable to distinguish between group 1 and group 2. JPE could distinguish between group 1 and group 2 when considering the reconstructed limb alone (p < 0.02). All four diagnostic screening values for JPE were equal or higher than in the other criteria. JPE also showed the most significant correlation with patient satisfaction.
Joint Play Envelope is an objective measure that demonstrated improved predictive value as compared to other tests when used as a measure of satisfaction in patients with ACL reconstructed knees.
本研究旨在确定重建膝关节和健康膝关节中与前交叉韧带（ACL）重建术后患者满意度相关的生物力学因素。
对17例接受单侧ACL重建的患者进行术后9年的随访。患者完成主观问卷调查，并接受手动膝关节松弛度测试（拉赫曼 - 特里拉特试验、KT - 1000试验和轴移试验）以及自动松弛度测试。在自动测试过程中，双腿先向外旋转然后向内旋转，直到峰值旋转扭矩达到5.65牛米。根据扭矩和旋转数据生成负荷 - 变形曲线。提取曲线特征进行分析。将KT - 1000测试期间的总腿部旋转和前向松弛度合并为一个单一因素（关节活动范围或JPE）。根据患者满意度得分将患者分为几组（第1组：较高满意度；第2组：较低满意度；第3组：不满意）。比较第1组和第2组之间的负荷 - 变形曲线特征和手动松弛度测试结果，以确定哪些生物力学因素可以区分这两组。计算KT - 1000测试、轴移试验、总腿部旋转和JPE的诊断筛查值。
在手动测试中，比较第1组和第2组的重建膝关节时，生物力学因素没有显著差异。在第2组中比较重建膝关节和健康膝关节时，重建膝关节在KT - 1000手动最大测试中的位移明显更高（p < 0.002）。仅考虑重建膝关节时，轴移试验结果和KT - 1000测试都无法区分第1组和第2组。在自动测试中，比较重建下肢时，各组之间没有显著差异。与第1组的健康下肢相比，第2组的健康下肢有更多的最大外旋（p < 0.02）且在最大外旋时刚度降低（p < 0.02）。总腿部旋转无法区分第1组和第2组。仅考虑重建肢体时，JPE可以区分第1组和第2组（p < 0.02）。JPE的所有四个诊断筛查值均等于或高于其他标准。JPE与患者满意度也显示出最显著的相关性。
关节活动范围是一种客观测量方法，在用于衡量ACL重建膝关节患者的满意度时，与其他测试相比具有更高的预测价值。
