Pamukoff Derek N, Montgomery Melissa M, Holmes Skylar C, Moffit Tyler J, Garcia Steven A, Vakula Michael N
Department of Kinesiology, California State University, Fullerton, Fullerton, CA, USA.
Department of Kinesiology, California State University, Fullerton, Fullerton, CA, USA.
Gait Posture. 2018 Sep;65:221-227. doi: 10.1016/j.gaitpost.2018.07.174. Epub 2018 Jul 24.
Individuals with anterior cruciate ligament reconstruction (ACLR) are at greater risk for knee osteoarthritis, which may be in part due to altered gait biomechanics. Articular cartilage thickness is typically imaged using magnetic resonance imaging, which is costly and lacks portability. Ultrasonography may provide an alternative imaging method for articular cartilage. It is unclear if ultrasonographic measurements of cartilage thickness are associated with gait biomechanics in individuals with ACLR.
To evaluate the association between sagittal and frontal plane knee mechanics during gait and resting femoral cartilage thickness from ultrasonography.
Twenty-five females with ACLR (age = 21.7 ± 2.6 years, time since ACLR = 60.6 ± 24.8 months) completed assessments of walking biomechanics and resting femoral cartilage thickness. Linear regression examined the association between gait biomechanics and cartilage thickness at the medial (MC) and lateral (LC) femoral condyles, and intercondylar notch (IC) after accounting for time since ACLR, meniscal injury, and gait speed.
In the ACLR limb, larger vertical ground reaction force (ΔR = 0.21, pΔ = 0.03), knee flexion angle (ΔR = 0.15, pΔ = 0.05), knee flexion excursion (KFE) (ΔR = 0.16, pΔ = 0.04), and knee flexion impulse (KFI) (ΔR = 0.23, pΔ = 0.02) were associated with thicker MC cartilage. A larger knee adduction angle (ΔR = 0.20, pΔ = 0.03) and knee adduction moment (KAM) (ΔR = 0.20, pΔ = 0.03) were associated with thinner MC thickness. Larger KFE (ΔR = 0.20, pΔ = 0.03) was associated with thicker LC cartilage. Gait biomechanics were not associated with IC cartilage thickness. After accounting for co-variates, the combination of KFI and KAM was predictive of MC thickness (ΔR = 0.37, pΔ = 0.01; Total R = 0.52, p = 0.02). Meniscal injury, KAM, and KFI were significant predictors in the model. In the contralateral limb, KFE was associated with thicker MC cartilage (ΔR = 0.16, pΔ = 0.05).
Sagittal and frontal plane knee mechanics during gait are uniquely associated with ultrasonographic measurements of femoral cartilage thickness in individuals with ACLR. Furthermore, concomitant medial meniscal injury was associated with thinner MC cartilage.
前交叉韧带重建（ACLR）患者患膝骨关节炎的风险更高，这可能部分归因于步态生物力学改变。关节软骨厚度通常使用磁共振成像进行成像，其成本高昂且缺乏便携性。超声检查可能为关节软骨提供一种替代成像方法。目前尚不清楚超声测量的软骨厚度是否与ACLR患者的步态生物力学相关。
评估步态期间矢状面和额状面膝关节力学与超声测量的静息股骨软骨厚度之间的关联。
25名ACLR女性患者（年龄=21.7±2.6岁，ACLR后时间=60.6±24.8个月）完成了步行生物力学和静息股骨软骨厚度评估。线性回归分析在考虑ACLR后时间、半月板损伤和步态速度后，研究了步态生物力学与股骨内侧髁（MC）、外侧髁（LC）以及髁间切迹（IC）处软骨厚度之间的关联。
在ACLR侧肢体中，更大的垂直地面反作用力（ΔR=0.21，pΔ=0.03）、膝关节屈曲角度（ΔR=0.15，pΔ=0.05）、膝关节屈曲 excursion（KFE）（ΔR=0.16，pΔ=0.04）和膝关节屈曲冲量（KFI）（ΔR=0.23，pΔ=0.02）与MC软骨较厚相关。更大的膝关节内收角度（ΔR=0.20，pΔ=0.03）和膝关节内收力矩（KAM）（ΔR=0.20，pΔ=0.03）与MC厚度较薄相关。更大 的KFE（ΔR=0.20，pΔ=0.03）与LC软骨较厚相关。步态生物力学与IC软骨厚度无关。在考虑协变量后，KFI和KAM的组合可预测MC厚度（ΔR=0.37，pΔ=0.01；总R=0.52，p=0.02）。半月板损伤、KAM和KFI是该模型中的显著预测因素。在对侧肢体中，KFE与MC软骨较厚相关（ΔR=0.16，pΔ=0.05）。
步态期间矢状面和额状面膝关节力学与ACLR患者股骨软骨厚度的超声测量值存在独特关联。此外，合并内侧半月板损伤与MC软骨较薄相关。
