Johnston Christopher D, Goodwin Jonathan S, Spang Jeffery T, Pietrosimone Brian, Blackburn J Troy
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA; Program in Human Movement Science, University of North Carolina at Chapel Hill, USA.
Department of Orthopaedics, University of North Carolina at Chapel Hill, USA.
J Biomech. 2019 Jan 3;82:103-108. doi: 10.1016/j.jbiomech.2018.10.011. Epub 2018 Oct 25.
Anterior cruciate ligament reconstruction (ACLR) restores joint stability following ACL injury but does not attenuate the heightened risk of developing knee osteoarthritis. Additionally, patellar tendon (PT) grafts incur a greater risk of osteoarthritis compared to hamstring grafts (HT). Aberrant gait biomechanics, including greater loading rates (i.e. impulsive loading), are linked to the development of knee osteoarthritis. However, the role of graft selection on walking gait biomechanics linked to osteoarthritis is poorly understood, thus the purpose of this study was to compare walking gait biomechanics between individuals with HT and PT grafts. Ninety-eight (74 PT; 24 HT) subjects with a history of ACLR performed walking gait at a self-selected speed from which the peak vertical ground reaction force (vGRF) during the first 50% of the stance phase and its instantaneous loading rate, peak internal knee extension and valgus moments, and peak knee flexion and varus angles were obtained. When controlling for time since ACLR and quadriceps strength, there were no differences in any kinetic or kinematic variables between graft types. While not significant, 44% of the PT cohort were identified as impulsive loaders (displaying a heelstrike transient in the majority of walking trials) compared to only 25% of the HT cohort (odds ratio = 2.3). This more frequent observation of impulsive loading may contribute to the greater risk of osteoarthritis with PT grafts. Future research is necessary to determine if impulsive loading and small magnitude differences between graft types contribute to osteoarthritis risk when extrapolated over thousands of steps per day.
前交叉韧带重建术（ACLR）可在 ACL 损伤后恢复关节稳定性，但并不能降低发生膝关节骨关节炎的高风险。此外，与腘绳肌移植物（HT）相比，髌腱（PT）移植物发生骨关节炎的风险更高。异常的步态生物力学，包括更高的负荷率（即冲击性负荷），与膝关节骨关节炎的发展有关。然而，移植物选择对与骨关节炎相关的步行步态生物力学的作用尚不清楚，因此本研究的目的是比较接受 HT 和 PT 移植物的个体之间的步行步态生物力学。98 名（74 名 PT；24 名 HT）有 ACLR 病史的受试者以自我选择的速度进行步行步态测试，从中获取站立期前 50% 期间的峰值垂直地面反作用力（vGRF）及其瞬时负荷率、膝关节最大伸展和外翻力矩，以及膝关节最大屈曲和内翻角度。在控制 ACLR 后的时间和股四头肌力量时，不同移植物类型之间的任何动力学或运动学变量均无差异。虽然差异不显著，但 44% 的 PT 队列被确定为冲击性负荷者（在大多数步行试验中表现出足跟撞击瞬态），而 HT 队列中这一比例仅为 25%（优势比 = 2.3）。这种更频繁观察到的冲击性负荷可能导致 PT 移植物发生骨关节炎的风险更高。未来有必要进行研究，以确定当每天进行数千步的步行时，冲击性负荷和移植物类型之间的微小差异是否会导致骨关节炎风险增加。
