Smith Colin R, Brandon Scott C E, Thelen Darryl G
Department of Mechanical Engineering, University of Wisconsin-Madison, USA.
Department of Mechanical Engineering, University of Wisconsin-Madison, USA; School of Engineering, University of Guelph, Canada.
J Biomech. 2019 Jan 3;82:124-133. doi: 10.1016/j.jbiomech.2018.10.008. Epub 2018 Oct 25.
Injuries to the anterior cruciate ligament (ACL) and menisci commonly lead to early onset osteoarthritis. Treatments that can restore normative cartilage loading patterns may mitigate the risk of osteoarthritis, though it is unclear whether such a goal is achievable through conservative rehabilitation. We used musculoskeletal simulation to predict cartilage and ligament loading patterns during walking in intact, ACL deficient, menisci deficient, and ACL-menisci deficient knees. Stochastic simulations with varying coordination strategies were then used to test whether neuromuscular control could be modulated to restore normative knee mechanics in the pathologic conditions. During early stance, a 3 mm increase in anterior tibial translation was predicted in the ACL deficient knee. Mean cartilage contact pressure increased by 18% and 24% on the medial and lateral plateaus, respectively, in the menisci deficient knee. Variations in neuromuscular coordination were insufficient to restore normative cartilage contact patterns in either the ACL or menisci deficient knees. Elevated cartilage contact pressures in the pathologic knees were observed in regions where cartilage wear patterns have previously been reported. These results suggest that altered cartilage tissue loading during gait may contribute to region-specific degeneration patterns, and that varying neuromuscular coordination in isolation is unlikely to restore normative knee mechanics.
前交叉韧带（ACL）和半月板损伤通常会导致早期骨关节炎。能够恢复正常软骨负荷模式的治疗方法可能会降低患骨关节炎的风险，不过目前尚不清楚通过保守康复能否实现这一目标。我们使用肌肉骨骼模拟来预测完整膝关节、ACL缺失膝关节、半月板缺失膝关节以及ACL-半月板均缺失膝关节在行走过程中的软骨和韧带负荷模式。随后，我们运用具有不同协调策略的随机模拟来测试是否可以通过调节神经肌肉控制，在病理状态下恢复正常的膝关节力学。在早期站立阶段，预计ACL缺失膝关节的胫骨前移会增加3毫米。在半月板缺失膝关节中，内侧和外侧平台的平均软骨接触压力分别增加了18%和24%。神经肌肉协调的变化不足以在ACL或半月板缺失膝关节中恢复正常的软骨接触模式。在先前报道过软骨磨损模式的区域，观察到了病理膝关节中升高的软骨接触压力。这些结果表明，步态期间软骨组织负荷的改变可能会导致特定区域的退变模式，而且单独改变神经肌肉协调不太可能恢复正常的膝关节力学。
