Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast Campus, Gold Coast, Australia.
School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Australia.
J Orthop Res. 2024 Jul;42(7):1428-1437. doi: 10.1002/jor.25814. Epub 2024 Feb 23.
Altered semitendinosus (ST) morphology and distal tendon insertion following anterior cruciate ligament reconstruction (ACLR) may reduce knee flexion torque generating capacity of the hamstrings via impaired ST force generation and/or moment arm. This study used a computational musculoskeletal model to simulate mechanical consequences of tendon harvest for ACLR on ST function by modeling changes in ST muscle tendon insertion point, moment arm, and torque generating capacity across a physiological range of motion. Simulated ST function was then compared between ACLR and uninjured contralateral limbs. Magnetic resonance imaging from 18 individuals with unilateral history of ACLR involving a hamstring autograft was used to analyse bilateral hamstring muscle (ST, semimembranosus, bicep femoris long head and short head) morphology and distal ST tendon insertion. The ACLR cohort was sub-grouped into those with and without ST regeneration. For each participant with ST regeneration (n = 7), a personalized musculoskeletal model was created including postoperative remodeling of ST using OpenSim 4.1. Knee flexion and internal rotation moment arms and torque generating capacities of hamstrings were evaluated. Bilateral differences were calculated with an asymmetry index (%) ([unaffected limb-affected limb]/[unaffected limb + affected limb]*100%). Smaller moment arms or knee torques within injured compared to uninjured contralateral limbs were considered a deficit. Compared to uninjured contralateral limbs, ACLR limbs with tendon regeneration (n = 7) had minor reductions in knee flexion (5.80% [95% confidence interval (CI) = 3.97-7.62]) and internal rotation (4.92% [95% CI = 2.77-7.07]) moment arms. Decoupled from muscle morphology, altered ST moment arms in ACLR limbs with tendon regeneration resulted in negligible deficits in knee flexion (1.20% [95% CI = 0.34-2.06]) and internal rotation (0.24% [95% CI = 0.22-0.26]) torque generating capacity compared to uninjured contralateral limbs. Coupled with muscle morphology, ACLR limbs with tendon regeneration had substantial deficits in knee flexion (19.32% [95% CI = 18.35-20.28]) and internal rotation (15.49% [95% CI = 14.56-16.41]) torques compared to uninjured contralateral limbs. Personalized musculoskeletal models with measures of ST distal insertion and muscle morphology provided unique insights into post-ACLR ST and hamstring function. Deficits in knee flexor and internal rotation moment arms and torque generating capacities were evident in those with ACLR even when tendon regeneration occurred. Future studies may wish to implement this framework in personalized musculoskeletal models following ACLR to better understand individual muscle function for injury prevention and treatment evaluation.
前交叉韧带重建 (ACLR) 后半腱肌 (ST) 形态和远端肌腱止点改变可能会通过降低 ST 肌力生成和/或力臂来降低腘绳肌的膝关节屈曲力矩生成能力。本研究使用计算肌肉骨骼模型通过模拟 ST 肌肉肌腱止点、力臂和力矩生成能力在生理运动范围内的变化,来模拟 ACLR 对 ST 功能的肌腱采集的力学后果。然后比较 ACLR 和未受伤的对侧肢体的模拟 ST 功能。使用 18 名单侧 ACLR 病史患者的磁共振成像分析双侧腘绳肌(ST、半膜肌、股二头肌长头和短头)形态和远端 ST 肌腱止点。将 ACLR 队列分为有和没有 ST 再生的亚组。对于每个有 ST 再生的参与者(n=7),使用 OpenSim 4.1 创建包括使用术后重塑 ST 的个性化肌肉骨骼模型。评估了膝关节屈曲和内旋力矩臂和腘绳肌的力矩生成能力。用不对称指数(%)计算双侧差异([未受伤肢体-受伤肢体]/[未受伤肢体+受伤肢体]×100%)。与未受伤的对侧肢体相比,受伤肢体的较小的力矩臂或膝关节力矩被认为是一种缺陷。与未受伤的对侧肢体相比,有肌腱再生的 ACLR 肢体(n=7)的膝关节屈曲(5.80% [95%置信区间(CI)=3.97-7.62])和内旋(4.92% [95% CI=2.77-7.07])力矩臂有较小的减少。与肌肉形态分离,有肌腱再生的 ACLR 肢体的 ST 力矩臂改变导致膝关节屈曲(1.20% [95% CI=0.34-2.06])和内旋(0.24% [95% CI=0.22-0.26])的力矩生成能力与未受伤的对侧肢体相比仅有微小的缺陷。结合肌肉形态,有肌腱再生的 ACLR 肢体的膝关节屈曲(19.32% [95% CI=18.35-20.28])和内旋(15.49% [95% CI=14.56-16.41])力矩与未受伤的对侧肢体相比有明显的缺陷。带有 ST 远端插入和肌肉形态测量值的个性化肌肉骨骼模型提供了 ACLR 后 ST 和腘绳肌功能的独特见解。即使发生肌腱再生,ACLR 患者的膝关节屈肌和内旋力矩臂以及力矩生成能力也存在缺陷。未来的研究可能希望在 ACLR 后在个性化肌肉骨骼模型中实施该框架,以更好地了解个体肌肉功能,从而预防和治疗损伤。
Knee Surg Sports Traumatol Arthrosc. 2019-4-27
Knee Surg Sports Traumatol Arthrosc. 2025-7