Planckaert Célia, Larose Gabriel, Ranger Pierre, Lacelle Marc, Fuentes Alexandre, Hagemeister Nicola
École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada.
Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada.
Arch Orthop Trauma Surg. 2018 Apr;138(4):553-561. doi: 10.1007/s00402-018-2873-5. Epub 2018 Jan 10.
Up to 20% of total knee arthroplasty patients remain unsatisfied post-surgery, and a large proportion of them report anterior knee pain. This study aims to verify whether patients who experience anterior knee pain after total knee arthroplasty (TKA) will exhibit kinematic characteristics similar to those associated with patellofemoral syndrome, including in the frontal and transverse planes.
Using four different assessment methods [radiological, patient-reported outcome, musculoskeletal assessment with functional performance testing, and a 3D kinematic assessment during gait], the clinical and 3D knee kinematic profiles of three groups were compared: a painful and an asymptomatic TKA group and a healthy control group. All three groups underwent a three-dimensional kinematic knee assessment while walking on a treadmill. Prosthetic component rotation was assessed through a CT scan measurement performed by one experienced radiologist. Flexion/extension, ab/adduction, and tibial internal rotation curves were compared, and significant differences were highlighted through ANCOVA analysis performed on SPSS.
A total of 62 knees were evaluated, 24 asymptomatic, 21 painful, and 17 control. A dynamic flexion contracture during gait was observed in the painful group, which was associated with a lack of flexibility of the thigh muscles. Moreover, painful TKA cases exhibited a valgus alignment (- 1.5°) during stance, which increases the Q angle and lateralizes the patella. Finally, CT scan evaluation of painful total knee arthroplasty patients revealed that their combined components rotation was in slight internal rotation (- 1.4°, SD 7.0°).
Painful TKA patients presented three well-known characteristics that tend to increase patellofemoral forces and that could be the cause of the unexplained pain: a stiff knee gait, a valgus alignment when walking, and combined TKA components slightly internally rotated.
高达20%的全膝关节置换术患者术后仍不满意，其中很大一部分报告有膝前疼痛。本研究旨在验证全膝关节置换术（TKA）后出现膝前疼痛的患者是否会表现出与髌股关节综合征相关的运动学特征，包括在额状面和横断面。
使用四种不同的评估方法[影像学、患者报告结局、功能性能测试的肌肉骨骼评估以及步态期间的三维运动学评估]，比较三组的临床和三维膝关节运动学特征：疼痛的TKA组、无症状的TKA组和健康对照组。所有三组在跑步机上行走时均接受三维膝关节运动学评估。通过一名经验丰富的放射科医生进行的CT扫描测量来评估假体组件的旋转。比较屈伸、内收/外展和胫骨内旋曲线，并通过在SPSS上进行的协方差分析突出显示显著差异。
共评估了62个膝关节，24个无症状，21个疼痛，17个对照。在疼痛组中观察到步态期间的动态屈曲挛缩，这与大腿肌肉缺乏灵活性有关。此外，疼痛的TKA病例在站立时表现出外翻对线（-1.5°），这增加了Q角并使髌骨向外侧移位。最后，对疼痛性全膝关节置换术患者的CT扫描评估显示，他们的组合组件旋转处于轻微内旋（-1.4°，标准差7.0°）。
疼痛性TKA患者呈现出三个众所周知的特征，这些特征往往会增加髌股关节力，并且可能是不明原因疼痛的原因：僵硬的膝关节步态、行走时的外翻对线以及组合的TKA组件轻微内旋。
