前平面膝关节力学与前交叉韧带重建患者早期软骨退变：一项纵向研究。
Frontal Plane Knee Mechanics and Early Cartilage Degeneration in People With Anterior Cruciate Ligament Reconstruction: A Longitudinal Study.
机构信息
Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA.
Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
出版信息
Am J Sports Med. 2018 Feb;46(2):378-387. doi: 10.1177/0363546517739605. Epub 2017 Nov 10.
BACKGROUND
Abnormal frontal plane gait mechanics are known risk factors for knee osteoarthritis, but their role in early cartilage degeneration after anterior cruciate ligament reconstruction (ACLR) is not well understood. Hypothesis/Purpose: The objective was to evaluate the association of frontal plane gait mechanics with medial knee cartilage magnetic resonance (MR) relaxation times over 1 year in patients with ACLR and controls. It was hypothesized that (1) there will be an increase in frontal plane medial knee loading and medial knee MR relaxation times over time in the patients with ACLR, and (2) increases in frontal plane medial knee loading will be associated with an increase in medial knee MR relaxation times.
STUDY DESIGN
Case-control study; Level of evidence, 3.
METHODS
Patients with ACLR (n = 37) underwent walking gait analyses and bilateral quantitative MR imaging (MRI) before surgery and at 6 and 12 months after ACLR. Healthy control participants (n = 13) were evaluated at baseline and 12 months. Gait variables included peak knee adduction moment (KAM), KAM impulse, and peak knee adduction angle. MRI variables included medial femur and medial tibia whole compartment and subregional T and T relaxation times. Statistical analyses included a comparison of changes over time for gait and MRI variables, correlations between changes in gait and MRI variables over time, and differences in change in MRI variables in patients who showed an increase versus decrease in KAM impulse.
RESULTS
There were significant increases in medial T (Δ 4%-11%) and T (Δ 2%-10%) relaxation times from baseline to 6 months for both knees in the ACLR group and in KAM (Δ 13%) for the injured knee. From baseline to 6 months, patients who had an increase in KAM impulse in the injured knee had a greater increase in medial T and T relaxation times as compared with those who did not have an increase in KAM impulse. Longitudinal changes for the control group were not significant.
CONCLUSION
There is an increase in medial knee relaxation times over the first 6 months after ACLR. People with an increase in medial knee loading show an increase in medial knee relaxation times when compared with those who do not have an increase in medial knee loading over the first 6 months.
背景
异常的额状面步态力学是膝关节骨关节炎的已知危险因素，但在前交叉韧带重建（ACLR）后早期软骨退变中的作用尚不清楚。假设/目的：本研究旨在评估 ACLR 患者和对照组患者额状面步态力学与内侧膝关节软骨磁共振（MR）弛豫时间之间的关系。假设（1）在 ACLR 患者中，随着时间的推移，内侧膝关节额状面负荷和内侧膝关节 MR 弛豫时间将增加；（2）内侧膝关节额状面负荷的增加将与内侧膝关节 MR 弛豫时间的增加相关。
研究设计
病例对照研究；证据水平，3 级。
方法
37 例 ACLR 患者接受了行走步态分析和双侧定量 MRI（MRI）检查，分别在术前、ACL 重建后 6 个月和 12 个月进行。13 例健康对照组参与者在基线和 12 个月时进行评估。步态变量包括峰值膝关节内收力矩（KAM）、KAM 冲量和峰值膝关节内收角度。MRI 变量包括内侧股骨和胫骨整体和亚区 T1 和 T2 弛豫时间。统计分析包括比较步态和 MRI 变量随时间的变化，比较随时间变化的步态和 MRI 变量之间的相关性，以及在 KAM 冲量增加和减少的患者中 MRI 变量变化的差异。
结果
在 ACLR 组，双侧膝关节的内侧 T1（增加 4%-11%）和 T2（增加 2%-10%）弛豫时间从基线到 6 个月时均显著增加，受伤膝关节的 KAM 增加（增加 13%）。从基线到 6 个月，受伤膝关节 KAM 冲量增加的患者，内侧 T1 和 T2 弛豫时间的增加大于 KAM 冲量无增加的患者。对照组的纵向变化不显著。
结论
在 ACLR 后最初的 6 个月内，内侧膝关节的弛豫时间增加。与内侧膝关节负荷无增加的患者相比，内侧膝关节负荷增加的患者在最初的 6 个月内，内侧膝关节的弛豫时间增加。
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