The University of Sydney, Faculty of Health Sciences, Lidcombe, Australia.
North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.
Am J Sports Med. 2019 Mar;47(3):590-597. doi: 10.1177/0363546518812883. Epub 2018 Dec 10.
There is evidence that frontal plane knee joint motion plays a crucial role in the pathogenesis of knee osteoarthritis, yet investigation of individuals with chronic anterior cruciate ligament-deficient (ACLD) knees remains sparse.
To investigate (1) if individuals with chronic ACLD knees demonstrate higher biomechanical measures of medial knee load as compared with their anterior cruciate ligament-intact (ACLI) knees, (2) if differences in static knee alignment of the ACLD knee will demonstrate a difference in the magnitude of biomechanical measures of medial knee load when compared with the ACLI knee, and (3) the side-to-side concordance of varus thrust among individuals with chronic ACLD knees.
Descriptive laboratory study.
Participants were sourced from a metropolitan orthopaedic surgeon group. Those who met the inclusion criteria and agreed to participate underwent a 3-dimensional gait analysis assessment to measure knee adduction moment (KAM), knee flexion moment (KFM), KAM peaks, KAM impulse, and varus thrust. Frontal plane knee static alignment was measured with a digital inclinometer fixed to medical calipers. The participants were divided according to their static knee alignment (neutral, varus, and valgus) for subgroup analysis. Peak knee angular velocity and frontal plane knee angle were used to establish if a participant was walking with a knee thrust. An individual was deemed to have knee thrust during gait if the largest frontal plane knee movement coincided with the peak knee angular velocity that occurred within the first 30% of stance phase.
Forty-five participants were recruited. The mean (SD) time from injury was 34.5 (55.6) months. ACLD knees did not demonstrate higher mean KAM and KFM ( P > .5) or early-stance peak KAM ( P = .3-.8) and KAM impulse ( P = .3-.9) as compared with ACLI knees as a whole group or when the varus, neutral, and valgus alignment subgroups were investigated separately. Twenty-three percent (n = 9) of the participants had a varus thrust at the ACLD or ACLI knee, 44% (n = 4) had a varus thrust at the ACLD knee, and 22% (n = 2) had varus thrust at both knees.
There were no side-to-side differences in mean KAM and KFM and early-stance peak KAM and KAM impulse among high-functioning individuals with chronic unilateral ACLD knees. There was a low prevalence of varus thrust among high-functioning individuals with chronic unilateral ACLD knees.
有证据表明，膝关节额状面运动在膝骨关节炎的发病机制中起着至关重要的作用，但对慢性前交叉韧带缺失（ACL）膝关节患者的研究仍然很少。
探讨（1）慢性 ACL 膝关节患者的内侧膝关节负荷生物力学测量值是否高于其前交叉韧带完整（ACL）膝关节，（2）ACL 膝关节的静态膝关节对线差异是否会导致内侧膝关节负荷生物力学测量值与 ACL 膝关节相比存在差异，以及（3）慢性 ACL 膝关节患者的内翻推力的双侧一致性。
描述性实验室研究。
参与者来自大都会骨科医生小组。符合纳入标准并同意参与的参与者接受了 3 维步态分析评估，以测量膝关节内收力矩（KAM）、膝关节弯曲力矩（KFM）、KAM 峰值、KAM 冲量和内翻推力。额状面膝关节静态对线使用固定在医用卡尺上的数字测斜仪进行测量。根据患者的静态膝关节对线（中立位、内翻位和外翻位）进行亚组分析。峰值膝关节角速度和额状面膝关节角度用于确定参与者是否存在膝关节推力。如果最大额状面膝关节运动与第一次支撑相 30%内发生的峰值膝关节角速度相吻合，则认为个体在步态中存在膝关节推力。
共招募了 45 名参与者。受伤后的平均（SD）时间为 34.5（55.6）个月。ACL 膝关节的平均 KAM 和 KFM 均不高（P>.5）或早期站立峰值 KAM（P=.3-.8）和 KAM 冲量（P=.3-.9）与 ACL 膝关节整体或当调查内翻、中立和外翻对线亚组时，ACL 膝关节均无差异。23%（n=9）的参与者在 ACL 或 ACL 膝关节出现内翻推力，44%（n=4）的参与者在 ACL 膝关节出现内翻推力，22%（n=2）的参与者在双侧膝关节出现内翻推力。
在慢性单侧 ACL 膝关节功能良好的患者中，平均 KAM 和 KFM 以及早期站立峰值 KAM 和 KAM 冲量无侧间差异。在慢性单侧 ACL 膝关节功能良好的患者中，内翻推力的发生率较低。
