Jalali Maryam, Farahmand Farzam, Esfandiarpour Fateme, Golestanha Seyed Ali, Akbar Mohammad, Eskandari Amirhosein, Mousavi Seyed Ebrahim
Orthotics & Prosthetics Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
Gait Posture. 2018 Jun;63:52-57. doi: 10.1016/j.gaitpost.2018.04.022. Epub 2018 Apr 22.
Functional knee braces are extensively used for partially and completely torn anterior cruciate ligament (ACL) patients and those who have undergone ACL graft reconstruction, in order to support the healing ACL, improve the joint's functional stability, and restore the normal joint kinematics.
Does wearing braces alter the arthrokinematics of the ACL deficient knees during lung exercise?
For ten male unilateral ACL deficient subjects, 3D knee models were reconstructed from CT images, acquired in rest position. Sagittal plane fluoroscopy was then performed throughout a complete cycle of lunge in braced and non-braced conditions. The 3D kinematics of the knees were obtained using a 2D-3D registration method in which six anatomical bony landmarks on the fluoroscopic images were matched with those on the 3D models.
No significant difference was found between the tibial anterior-posterior translations and abduction-adduction motions of the braced and non-braced knees. A significant decrease, however, was observed after bracing in the tibial internal rotation at 45° flexion during eccentric (non-braced: 5.9° (±6.7°) vs. braced: 2.4° (±7.0°); p = 0.045), and at 30° flexion during concentric (non-braced: 2.3° (±6.9°) vs. braced: -1.6° (±8.1°); p = 0.001) phases of the lunge cycle.
The immediate effect of knee bracing is limited to controlling the tibial rotation of the ACL deficient individuals during the lunge exercise. Hence, care should be taken in prescribing the lunge exercise for rehabilitation of ACL injured patients with high anterior-posterior knee instability, even when wearing knee braces.
功能性膝关节支具广泛应用于部分和完全撕裂前交叉韧带（ACL）的患者以及接受ACL移植重建的患者，以支撑愈合中的ACL，改善关节功能稳定性，并恢复正常关节运动学。
佩戴支具是否会改变ACL缺损膝关节在弓步运动时的关节运动学？
对于10名男性单侧ACL缺损受试者，从静止位置获取的CT图像重建3D膝关节模型。然后在佩戴支具和不佩戴支具的情况下，在整个完整的弓步周期中进行矢状面荧光透视。使用二维-三维配准方法获得膝关节的3D运动学，其中荧光透视图像上的六个解剖学骨性标志与3D模型上的标志相匹配。
佩戴支具和未佩戴支具的膝关节在胫骨前后平移和内收-外展运动方面未发现显著差异。然而，在弓步周期的离心阶段（未佩戴支具：5.9°（±6.7°） vs. 佩戴支具：2.4°（±7.0°）；p = 0.045）和向心阶段（未佩戴支具：2.3°（±6.9°） vs. 佩戴支具：-1.6°（±8.1°）；p = 0.001），佩戴支具后在45°屈曲时胫骨内旋以及30°屈曲时均观察到显著降低。
膝关节支具的即时效果仅限于在弓步运动期间控制ACL缺损个体的胫骨旋转。因此，即使佩戴膝关节支具，在为具有高膝关节前后不稳定的ACL损伤患者开弓步运动康复处方时也应谨慎。
