前交叉韧带损伤后有或无骨髓水肿样病变的成人膝关节额状面生物力学
Knee Frontal-Plane Biomechanics in Adults With or Without Bone Marrow Edema-Like Lesions After Anterior Cruciate Ligament Injury.
作者信息
Thomas Abbey C, Palmieri-Smith Riann M
机构信息
Department of Kinesiology, University of North Carolina at Charlotte.
School of Kinesiology, University of Michigan, Ann Arbor.
出版信息
J Athl Train. 2017 Jun 2;52(6):581-586. doi: 10.4085/1062-6050-51.12.08.
CONTEXT
Lateral subchondral bone bruises (BBs) occur frequently with anterior cruciate ligament (ACL) injuries. These BBs are associated with pain during weight bearing, leading individuals to increase medial tibiofemoral loading to alleviate pain laterally. Increased medial tibiofemoral loading may precipitate the development or progression of posttraumatic osteoarthritis; however, no in vivo biomechanical data exist to confirm that lateral BBs increase medial tibiofemoral loading as measured by the external knee-adduction moment (KAM).
OBJECTIVE
To determine whether lateral BBs after ACL injury increase the external KAM during walking.
DESIGN
Descriptive laboratory study.
SETTING
University research laboratory.
PATIENTS OR OTHER PARTICIPANTS
Eleven volunteers with an ACL injury (age = 20.36 ± 4.03 years, height = 177.60 ± 8.59 cm, mass = 79.70 ± 16.33 kg), 12 with an ACL injury and a lateral BB (ACL + BB; age = 19.25 ± 5.58 years, height = 170.71 ± 9.40 cm, mass = 66.79 ± 11.91 kg), and 12 healthy controls (age = 19.67 ± 5.19 years, height = 173.29 ± 11.58 cm, mass = 67.07 ± 11.25 kg) participated.
INTERVENTION(S): We recorded peak KAM during 3 walking trials (1.1 ± 0.6 m/s) in which participants walked over a force platform located in the field of view of a motion-capture system.
MAIN OUTCOME MEASURE(S): Peak KAM was calculated during the first half of stance using standard inverse-dynamics analysis, averaged across trials, and examined via 1-way analysis of variance. Knee pain and function were determined from the International Knee Documentation Committee Subjective Knee Evaluation Form and compared among groups via the Kruskal-Wallis test.
RESULTS
Peak KAM did not differ among groups (ACL injury = 0.14 ± 0.07 Nm·kg·m, ACL + BB = 0.21 ± 0.08 Nm·kg·m, control = 0.20 ± 0.08 Nm·kg·m; F = 3.243, P = .052). Knee-pain frequency and severity were greater in the ACL-injury (frequency = 2.55 ± 1.81, severity = 3.36 ± 1.75; both P < .001) and ACL + BB (frequency = 3.58 ± 2.81, severity = 4.08 ± 3.20; both P < .001) groups than in the control group (frequency = 0.00 ± 0.00, severity = 0.00 ± 0.00). Knee function was greater in the control group (100.00 ± 0.00) than in the ACL-injury (59.35 ± 17.31; P < .001) and ACL + BB (46.46 ± 25.85; P < .001) groups.
CONCLUSIONS
The ACL + BB groups did not walk with a greater external KAM than the ACL-injury or control groups. Thus, lateral tibiofemoral BB did not influence knee frontal-plane loading after ACL injury.
背景
外侧软骨下骨挫伤（BBs）常与前交叉韧带（ACL）损伤同时出现。这些骨挫伤与负重时的疼痛相关，导致个体增加胫股内侧负荷以减轻外侧疼痛。胫股内侧负荷增加可能促使创伤后骨关节炎的发生或进展；然而，尚无体内生物力学数据证实外侧骨挫伤会增加通过外侧膝内收力矩（KAM）测量的胫股内侧负荷。
目的
确定ACL损伤后的外侧骨挫伤在行走过程中是否会增加外侧KAM。
设计
描述性实验室研究。
地点
大学研究实验室。
患者或其他参与者
11名ACL损伤志愿者（年龄 = 20.36 ± 4.03岁，身高 = 177.60 ± 8.59厘米，体重 = 79.70 ± 16.33千克），12名ACL损伤合并外侧骨挫伤的志愿者（ACL + BB；年龄 = 19.25 ± 5.58岁，身高 = 170.71 ± 9.40厘米，体重 = 66.79 ± 11.91千克），以及12名健康对照者（年龄 = 19.67 ± 5.19岁，身高 = 173.29 ± 11.58厘米，体重 = 67.07 ± 11.25千克）参与研究。
干预措施
我们在3次步行试验（速度为1.1 ± 0.6米/秒）中记录了峰值KAM，参与者在位于动作捕捉系统视野范围内的测力平台上行走。
主要观察指标
使用标准逆动力学分析计算站立前半段的峰值KAM，对各试验结果进行平均，并通过单因素方差分析进行检验。根据国际膝关节文献委员会主观膝关节评估表确定膝关节疼痛和功能，并通过Kruskal-Wallis检验在各组间进行比较。
结果
各组间峰值KAM无差异（ACL损伤组 = 0.14 ± 0.07牛米·千克·米，ACL + BB组 = 0.21 ± 0.08牛米·千克·米，对照组 = 0.20 ± 0.08牛米·千克·米；F = 3.243，P = 0.052）。ACL损伤组（频率 = 2.55 ± 1.81，严重程度 = 3.36 ± 1.75；P均 < 0.001）和ACL + BB组（频率 = 3.58 ± 2.81，严重程度 = 4.08 ± 3.20；P均 < 0.001）的膝关节疼痛频率和严重程度均高于对照组（频率 = 0.00 ± 0.00，严重程度 = 0.00 ± 0.00）。对照组的膝关节功能（100.00 ± 0.00）优于ACL损伤组（59.35 ± 17.31；P < 0.001）和ACL + BB组（46.46 ± 25.85；P < 0.001）。
结论
ACL + BB组行走时的外侧KAM并不高于ACL损伤组或对照组。因此，胫股外侧骨挫伤在ACL损伤后并未影响膝关节额状面负荷。
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