Milandri Giovanni, Posthumus Mike, Small T J, Bothma Adam, van der Merwe Willem, Kassanjee Reshma, Sivarasu Sudesh
Orthopaedic Biomechanics Lab, Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, South Africa.
Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Sports Science Institute of South Africa, Boundary Road, Newlands, South Africa.
Clin Biomech (Bristol). 2017 Nov;49:78-84. doi: 10.1016/j.clinbiomech.2017.07.012. Epub 2017 Jul 29.
Biomechanical deviations long (approx. 5years) after anterior cruciate ligament reconstruction have not been quantified in males, despite their distinct risk profile as compared to females. These deviations can indicate altered joint loading during chronic, repetitive motions.
Cross-sectional study, comparing kinematic and kinetic variables between 15 male anterior cruciate ligament reconstructed patients and 15 healthy controls. During walking and running gait, measurements were taken of impact dynamics, knee and hip sagittal plane angles and moments, and knee varus angles and adduction moments.
Comparing affected limbs to control limbs, significantly lower maximum (P=0.001) and initial (P=0.003) loading rates were found during running, but not in walking. Hip angles were lower for affected limbs of patients compared to the control group (P=0.039) in walking, but not during running. Between-limb comparisons showed important differences in symmetry of the affected patients. Maximum force during running was higher in the unaffected limb (P=0.015), which was linked with a higher loading rate (P=0.008). Knee flexion angle was reduced by 2° on average for the affected limb during running (P=0.010), and both walking and running knee and hip moments showed differences. Knee varus angle showed a 1° difference during walking (P<0.001), but not during running. Knee adduction moment was significantly lower (more valgus) during both walking and running.
Male anterior cruciate ligament reconstructed patients demonstrate persistent, clinically important gait asymmetries and differences from healthy controls long after surgery in kinematics, kinetics, and impact biomechanics.
尽管男性与女性相比有不同的风险特征，但前交叉韧带重建术后较长时间（约5年）的生物力学偏差尚未在男性中得到量化。这些偏差可能表明在慢性重复性运动中关节负荷发生了改变。
横断面研究，比较15例男性前交叉韧带重建患者和15例健康对照者的运动学和动力学变量。在步行和跑步步态期间，测量冲击动力学、膝关节和髋关节矢状面角度及力矩、膝关节内翻角度和内收力矩。
将患侧肢体与对照肢体进行比较，发现跑步时最大负荷率（P = 0.001）和初始负荷率（P = 0.003）显著较低，但步行时未出现这种情况。在步行时，患者患侧肢体的髋关节角度低于对照组（P = 0.039），但跑步时没有这种情况。肢体间比较显示，患侧患者在对称性方面存在重要差异。跑步时患侧肢体的最大力较高（P = 0.015），这与较高的负荷率有关（P = 0.008）。患侧肢体在跑步时平均屈膝角度减少2°（P = 0.010），步行和跑步时膝关节和髋关节力矩均存在差异。步行时膝关节内翻角度有1°差异（P<0.001），但跑步时没有。步行和跑步时膝关节内收力矩均显著较低（外翻更多）。
男性前交叉韧带重建患者在手术后很长时间内，在运动学、动力学和冲击生物力学方面表现出持续的、具有临床重要性的步态不对称以及与健康对照者的差异。
