Paediatric Orthopaedic Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
Paediatric Orthopaedic Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
Clin Biomech (Bristol). 2023 Aug;108:106067. doi: 10.1016/j.clinbiomech.2023.106067. Epub 2023 Aug 11.
Patellofemoral instability influences the gait pattern and activity level in adolescents. However, gait biomechanics to cope with recurrent patella instability and its relation to radiological findings has hardly been studied.
We retrospectively analyzed kinematic and kinetic gait analysis data, magnetic resonance images and X-ray of 32 adolescents with unilateral recurrent patellofemoral instability aged 12 to 18 years. Subjects were assigned to 3 groups based on their sagittal knee moment in the loading response and mid stance phase. Kinematic and kinetic differences among the groups were analyzed using a one-way ANOVA. A multinomial logistic regression model provided a further analysis of the relationship between gait biomechanics and MRI as well as X-ray parameters.
All three groups showed different characteristics of the knee kinematics during loading response and single stance: while the patella-norm-loading group showed a slightly reduced knee flexion (p 〈0,01), the patella-unloading group kept the knee nearly extended (p < 0,01) and patella-overloading group showed an increased knee flexion (p = 0,01) compared to the other groups. In single stance the patella-overloading group maintained increased knee flexion (p < 0,01) compared to patella-unloading group and patella-norm-loading group. None of the radiological parameters proved to be related to gait patterns.
The paper describes different gait coping strategies and their clinical relevance in subjects with patellofemoral instability. However, we did not find any relation of gait biomechanics to skeletal morphology.
髌股关节不稳定会影响青少年的步态模式和活动水平。然而，对于应对复发性髌股关节不稳定的步态生物力学及其与影像学发现的关系，几乎没有研究。
我们回顾性分析了 32 名 12 至 18 岁单侧复发性髌股关节不稳定青少年的运动学和动力学步态分析数据、磁共振成像和 X 射线。根据膝关节在负荷反应期和中站立期的矢状面膝关节力矩，将受试者分为 3 组。使用单因素方差分析分析组间运动学和动力学差异。多变量逻辑回归模型对步态生物力学与 MRI 和 X 射线参数之间的关系进行了进一步分析。
所有三组在负荷反应期和单足支撑期的膝关节运动学都表现出不同的特征：髌股规范负荷组的膝关节屈曲度略有减小（p〈0.01），髌股卸载组保持膝关节几乎伸展（p〈0.01），髌股过负荷组的膝关节屈曲度增加（p=0.01）与其他组相比。在单足支撑期，髌股过负荷组与髌股卸载组和髌股规范负荷组相比，膝关节屈曲度保持增加（p〈0.01）。没有任何影像学参数与步态模式相关。
本文描述了髌股关节不稳定患者不同的步态应对策略及其临床相关性。然而，我们没有发现步态生物力学与骨骼形态之间有任何关系。
