Department of Mechanical Engineering, University of Delaware, Newark, Delaware, USA.
Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA.
J Orthop Res. 2022 Sep;40(9):2025-2038. doi: 10.1002/jor.25250. Epub 2022 Jan 6.
Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty-five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two-tailed t-tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase.
前交叉韧带重建(ACLR)后步态改变是常见的,并与创伤后骨关节炎的发展有关。虽然在 ACLR 后几个时间点研究了膝关节步态改变,但对于这些生物力学变量在手术后 6 个月之前如何变化知之甚少,也不太了解它们在整个步态站立阶段如何不同。本研究的目的是在 ACLR 后 3 个月(3.2±0.5)和 6 个月(6.4±0.7)时通过整个站立阶段检查膝关节步态生物力学变量,并研究两个术后时间点之间的肢体间不对称性进展。35 名患者在 ACLR 后 3 个月(3.2±0.5)和 6 个月(6.4±0.7)时进行了地面行走的运动分析。通过统计参数映射,在整个站立阶段(100%)比较了肢体之间和时间点之间的膝关节生物力学变量;这包括 2×2(肢体×时间)重复测量方差分析和双侧 t 检验。患侧膝关节角度、力矩、伸肌力和内侧间室力小于健侧。在两个时间点都存在肢体间不对称,但在 6 个月时较少见。未受累肢体的生物力学变量随时间保持相对稳定,而受累肢体的生物力学变量则趋于不受累肢体。临床意义的陈述:ACL 后纠正不对称步态模式的干预措施可能需要在手术后早期进行,并且可能需要集中在站立阶段的多个部分。