Akpinar Berkcan, Baron Samuel, Alaia Michael J, Jazrawi Laith M
Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A.
Arthrosc Sports Med Rehabil. 2020 Sep 2;2(5):e553-e561. doi: 10.1016/j.asmr.2020.07.001. eCollection 2020 Oct.
To evaluate clinical and biomechanical outcomes after knee extensor mechanism reconstruction (KEMR).
Patients who underwent KEMR at our institution from 2011 to 2018 were identified. Patient-reported outcomes (Kujala, Lysholm, Tegner Activity Scale) were compiled at clinical follow-up. Isokinetic testing was conducted using the BioDex system 4 pro dynamometer at slow (60°/s), intermediate (180°/s), and fast (300°/s) speeds in a 9-patient subset.
From 2011 to 2018, 12 patients (12 knees, 10 male, 5 right, mean age: 54.3 ± standard deviation: 15.2 years) with KEM injuries requiring tendon reconstruction with a 1-year minimum follow up were identified. Postoperative follow-up was 42.6 months (range: 12.0-93.0 months). Procedures included patellar (7) and quadriceps tendon reconstruction (5). Postoperative versus preoperative Tegner Activity Scale scores demonstrated significant improvement (3.5 ± 2.5 vs 1.5 ± 1.2, n = 8, = .05). Postoperative versus preoperative Kujala scores significantly improved (70.3 ± 11.7 vs 43.6 ± 15.7, n = 8, = .010). There was significant improvement in preoperative to postoperative KEMR extension lag (29.4 ± 22.2° vs 0.83 ± 1.9°, = .002). Clinically, there was no difference in passive range of motion between the operative and contralateral knee. BioDex testing demonstrated decreased maximum work generated from the operative versus contralateral knee at slow (70.4 ± 30.4 Joules vs 101.9 ± 40.6 J; = .028), intermediate (52.0 ± 45.4 J vs 69.8 ± 63.7 J; = .038), and fast (43.8 ± 41.7 J vs 57.5 ± 53.8 J; = .050) speeds. Range of motion was less in the operative versus contralateral knee at all speeds: = .011, .038, and .024. The average peak torque generated per body weight was smaller in the operative versus contralateral knee at slow speed ( = .038).
Patients undergoing KEMR in this study have significantly improved clinical outcomes despite having strength deficits that persist postoperatively.
Therapeutic Case Series, Level IV.
评估膝关节伸肌机制重建（KEMR）后的临床和生物力学结果。
确定2011年至2018年在我们机构接受KEMR的患者。在临床随访时收集患者报告的结果（库贾拉、莱肖尔姆、特格纳活动量表）。在一个9名患者的亚组中，使用BioDex系统4专业测力计以慢（60°/秒）、中（180°/秒）和快（300°/秒）速度进行等速测试。
2011年至2018年，确定了12例（12膝，10例男性，5例右侧，平均年龄：54.3±标准差：15.2岁）KEM损伤需要肌腱重建且至少随访1年的患者。术后随访时间为42.6个月（范围：12.0 - 93.0个月）。手术包括髌腱重建（7例）和股四头肌肌腱重建（5例）。术后与术前特格纳活动量表评分显示有显著改善（3.5±2.5对1.5±1.2，n = 8，P = 0.05）。术后与术前库贾拉评分显著改善（70.3±11.7对43.6±15.7，n = 8，P = 0.010）。术前至术后KEMR伸展滞后有显著改善（29.4±22.2°对0.83±1.9°，P = 0.002）。临床上，手术侧膝关节与对侧膝关节的被动活动范围无差异。BioDex测试显示，在慢（70.4±30.4焦耳对101.9±40.6焦耳；P = 0.028）、中（52.0±45.4焦耳对69.8±63.7焦耳；P = 0.038）和快（43.8±41.7焦耳对57.5±53.8焦耳；P = 0.050）速度下，手术侧膝关节与对侧膝关节产生的最大功降低。在所有速度下，手术侧膝关节的活动范围均小于对侧膝关节：P = 0.011、0.038和0.024。在慢速度下，手术侧膝关节每体重产生的平均峰值扭矩小于对侧膝关节（P = 0.038）。
本研究中接受KEMR的患者临床结果有显著改善，尽管术后仍存在力量缺陷。
治疗性病例系列，IV级。
