Stephen Joanna, Alva Avinash, Lumpaopong Punyawan, Williams Andy, Amis Andrew A
Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, SW7 2AZ, UK.
Fortius Clinic, Fitzhardinge Street, London, W1H 6EQ, UK.
J Exp Orthop. 2018 Sep 10;5(1):34. doi: 10.1186/s40634-018-0150-8.
Vastus Medialis Muscles (VMM) damage has been widely identified following patellar dislocation. Rehabilitation programmes have been suggested to strengthen the VMM and reduce clinical symptoms of pain and instability. This controlled laboratory study investigated the hypothesis that reduced Vastus Medialis Obliquus (VMO) and Vastus Medialis Longus (VML) muscle tension would alter patellar tracking, stability and PFJ contact pressures.
Nine fresh-frozen dissected cadaveric knees were mounted in a rig with the quadriceps and iliotibial band loaded to 205 N. An optical tracking system measured joint kinematics and pressure sensitive film between the patella and trochlea measured PFJ contact pressures. Measurements were repeated for three conditions: 1. With all quadriceps heads and iliotibial band (ITB) loaded; 2. as 1, but with the VMO muscle unloaded and 3. as 1, but with the VMO and VML unloaded. Measurements were also repeated for the three conditions with a 10 N lateral displacement force applied to the patella.
Reduction of VMM tension resulted in significant increases in lateral patellar tilt (2.8°) and translation (4 mm), with elevated lateral and reduced medial joint contact pressures from 0.48 to 0.14 MPa, and reduced patellar stability (all p < 0.05).
These findings provide basic scientific rationale to support the role of quadriceps strengthening to resist patellar lateral maltracking and rebalance the articular contact pressure away from the lateral facet in patients with normal patellofemoral joint anatomy.
髌骨脱位后，股内侧肌（VMM）损伤已被广泛确认。有人提出康复计划来增强股内侧肌并减轻疼痛和不稳定的临床症状。这项对照实验室研究调查了以下假设：股内侧斜肌（VMO）和股内侧长肌（VML）肌肉张力降低会改变髌骨轨迹、稳定性和髌股关节（PFJ）接触压力。
将九个新鲜冷冻解剖的尸体膝关节安装在一个装置中，股四头肌和髂胫束加载至205 N。一个光学跟踪系统测量关节运动学，髌骨和滑车之间的压敏膜测量髌股关节接触压力。对三种情况重复进行测量：1. 所有股四头肌头和髂胫束（ITB）加载；2. 与情况1相同，但VMO肌肉未加载；3. 与情况1相同，但VMO和VML未加载。在对髌骨施加10 N侧向位移力的情况下，也对这三种情况重复进行测量。
股内侧肌张力降低导致髌骨外侧倾斜（2.8°）和移位（4 mm）显著增加，外侧关节接触压力升高，内侧关节接触压力从0.48 MPa降至0.14 MPa，髌骨稳定性降低（所有p < 0.05）。
这些发现提供了基本的科学依据，以支持在髌股关节解剖结构正常的患者中，增强股四头肌以抵抗髌骨外侧轨迹不良并使关节接触压力从外侧小面重新平衡的作用。
