Apostolopoulos Alexandros P, Najim Wissam Suhail, Fanous Rafik, Balfousias Theodore, Angelis Stavros, Zoumboulis George, Saavedra Enrique, Zafiropoulos George
Trauma and Orthopaedic Department, "Korgialenio-Benakio" Hellenic Red Cross Hospital, Athens, Greece; Trauma and Orthopaedic Department, Ealing Hospital, North West University Healthcare NHS Trust, London, United Kingdom.
Trauma and Orthopaedic Department, Al Ain Hospital, Al Ain, Abu Dhabi, UAE.
J Long Term Eff Med Implants. 2019;29(3):169-173. doi: 10.1615/JLongTermEffMedImplants.2019032873.
Patella height appears to have a crucial role in knee biomechanics. Patellar malalignment and maltracking are therefore believed to be associated with development and progression of patellofemoral pain and disease. Published data are scant regarding the effect of everyday tasks on patella height and patellofemoral disease. We included 150 subjects in a retrospective observational study. Group A had 75 subjects (24 male and 51 female, with a mean age of 58.5 yr), whose daily activities included squatting (the traditional Muslim praying position called Sujud). Group B had 75 subjects (42 male and 33 female, with a mean age of 47.6 yr), who were non-Muslim. Patella height was measured using Insall-Salvati (IS) and Blackburne-Peel (BP) ratios. The mean IS ratio was 0.86 (confidence interval [CI]: 0.7-1.02) for group A and 1.1 (CI: 0.96-1.23) for group B. The mean BP ratio was 0.66 (CI: 0.49-0.83) for group A and 0.89 (CI: 0.73-1.04) for group B. We found 26 subjects (34.7%) in group B to have patella alta, when measured by either ratio, compared to one subject (1.3%) in group A (p < 0.01) with patella alta. We found 61 subjects (81.3%) in group A to have patella baja, when measured by either ratio, compared to 21 subjects (28%) in group A (p < 0.01) with patella baja. In group A, the IS ratio was reduced in 29 subjects (38.7%), the BP ratio was reduced in 59 subjects (78.7%), and both were reduced in 27 subjects (36%). A similar pattern was noted for group B. Our results show that a significant increase in patella baja was associated with repeated squatting/kneeling, compared to the predominance of patella alta in the control group. On the basis of these findings, we hypothesize that biomechanical stresses associated with repeated hyperflexion of the knee asymmetrically affect the more flexible quadriceps muscle fibers greater than patella tendon fibers. Thus, repeated hyperflexion in everyday tasks leads to elongation of quadriceps fibers and patella baja.
髌骨高度似乎在膝关节生物力学中起着关键作用。因此，髌骨排列不齐和轨迹不良被认为与髌股关节疼痛和疾病的发生及发展有关。关于日常活动对髌骨高度和髌股关节疾病影响的已发表数据很少。我们纳入了150名受试者进行一项回顾性观察研究。A组有75名受试者（24名男性和51名女性，平均年龄58.5岁），其日常活动包括蹲踞（传统的穆斯林祈祷姿势，称为Sujud）。B组有75名受试者（42名男性和33名女性，平均年龄47.6岁），他们是非穆斯林。使用Insall-Salvati（IS）和Blackburne-Peel（BP）比率测量髌骨高度。A组的平均IS比率为0.86（置信区间[CI]：0.7 - 1.02），B组为1.1（CI：0.96 - 1.23）。A组的平均BP比率为0.66（CI：0.49 - 0.83），B组为0.89（CI：0.73 - 1.04）。通过两种比率测量，我们发现B组中有26名受试者（34.7%）存在高位髌骨，而A组中只有1名受试者（1.3%）存在高位髌骨（p < 0.01）。通过两种比率测量，我们发现A组中有61名受试者（81.3%）存在低位髌骨，而B组中有21名受试者（28%）存在低位髌骨（p < 0.01）。在A组中，29名受试者（38.7%）的IS比率降低，59名受试者（78.7%）的BP比率降低，27名受试者（36%）的两种比率均降低。B组也观察到类似模式。我们的结果表明，与对照组中高位髌骨占主导相比，反复蹲踞/跪姿与低位髌骨的显著增加有关。基于这些发现，我们推测与膝关节反复过度屈曲相关的生物力学应力对更易弯曲的股四头肌纤维的不对称影响大于髌腱纤维。因此，日常活动中的反复过度屈曲会导致股四头肌纤维伸长和低位髌骨。
