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膝关节内关节纤维性粘连会改变髌股关节接触生物力学。

Intraarticular arthrofibrosis of the knee alters patellofemoral contact biomechanics.

作者信息

Mikula Jacob D, Slette Erik L, Dahl Kimi D, Montgomery Scott R, Dornan Grant J, O'Brien Luke, Turnbull Travis Lee, Hackett Thomas R

机构信息

Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.

The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO, 81657, USA.

出版信息

J Exp Orthop. 2017 Dec 19;4(1):40. doi: 10.1186/s40634-017-0110-8.

DOI:10.1186/s40634-017-0110-8
PMID:29260429
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5736518/
Abstract

BACKGROUND

Arthrofibrosis in the suprapatellar pouch and anterior interval can develop after knee injury or surgery, resulting in anterior knee pain. These adhesions have not been biomechanically characterized.

METHODS

The biomechanical effects of adhesions in the suprapatellar pouch and anterior interval during simulated quadriceps muscle contraction from 0 to 90° of knee flexion were assessed. Adhesions of the suprapatellar pouch and anterior interval were hypothesized to alter the patellofemoral contact biomechanics and increase the patellofemoral contact force compared to no adhesions.

RESULTS

Across all flexion angles, suprapatellar adhesions increased the patellofemoral contact force compared to no adhesions by a mean of 80 N. Similarly, anterior interval adhesions increased the contact force by a mean of 36 N. Combined suprapatellar and anterior interval adhesions increased the mean patellofemoral contact force by 120 N. Suprapatellar adhesions resulted in a proximally translated patella from 0 to 60°, and anterior interval adhesions resulted in a distally translated patella at all flexion angles other than 15° (p < 0.05).

CONCLUSIONS

The most important finding in this study was that patellofemoral contact forces were significantly increased by simulated adhesions in the suprapatellar pouch and anterior interval. Anterior knee pain and osteoarthritis may result from an increase in patellofemoral contact force due to patellar and quadriceps tendon adhesions. For these patients, arthroscopic lysis of adhesions may be beneficial.

摘要

背景

髌上囊和前方间隙的关节纤维化可在膝关节损伤或手术后发生，导致膝关节前部疼痛。这些粘连尚未进行生物力学特征分析。

方法

评估了在膝关节从0°至90°屈曲过程中模拟股四头肌收缩时髌上囊和前方间隙粘连的生物力学效应。假设髌上囊和前方间隙的粘连会改变髌股关节接触生物力学，并与无粘连相比增加髌股关节接触力。

结果

在所有屈曲角度下，与无粘连相比，髌上囊粘连使髌股关节接触力平均增加80N。同样，前方间隙粘连使接触力平均增加36N。髌上囊和前方间隙联合粘连使髌股关节平均接触力增加120N。髌上囊粘连导致髌骨在0°至60°范围内向近端移位，前方间隙粘连导致髌骨在除15°以外的所有屈曲角度下向远端移位（p<0.05）。

结论

本研究中最重要的发现是，髌上囊和前方间隙的模拟粘连显著增加了髌股关节接触力。髌股关节接触力因髌腱和股四头肌肌腱粘连而增加，可能导致膝关节前部疼痛和骨关节炎。对于这些患者，关节镜下粘连松解可能有益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/50f071fb2576/40634_2017_110_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/2cc567e91889/40634_2017_110_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/87cc6fcccc1e/40634_2017_110_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/ebb97d001092/40634_2017_110_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/50f071fb2576/40634_2017_110_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/2cc567e91889/40634_2017_110_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/87cc6fcccc1e/40634_2017_110_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/ebb97d001092/40634_2017_110_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c06/5736518/50f071fb2576/40634_2017_110_Fig4_HTML.jpg

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