Rennbahnklinik, Muttenz, Switzerland.
Orthopädie und Traumatologie, Universitätsklinik Basel, Basel-Stadt, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2024 Oct;32(10):2601-2609. doi: 10.1002/ksa.12220. Epub 2024 May 1.
Previous evidence indicated that the tibiofemoral bone configuration might elevate the risk of an anterior cruciate ligament (ACL) injury. Furthermore, a low hamstring-to-quadriceps muscle ratio predisposes especially females to unfavourable knee kinematics. The primary objective of the present study was to investigate sex-specific associations between tibiofemoral bone geometry and isokinetic knee flexion torque in patients with primary ACL injury followed by ACL reconstruction.
N = 100 patients (72 = male, 28 = female, age = 31.3 ± 10.2, body mass index = 25.3 ± 3.6) with primary ACL rupture with isokinetic knee flexion torque assessments before and 6 months after ACL reconstruction surgery were analysed. Magnetic resonance imaging scans were analysed for medial posterior tibial slope (MPTS) and lateral posterior tibial slope, notch width index (NWI) and lateral femoral condyle index (LFCI). Additionally, isokinetic knee flexion torque (60°/s) and hamstring-quadriceps ratios were evaluated. Subsequently, functional parameters were correlated with imaging data for gender subgroups.
The findings showed that presurgical isokinetic knee flexion torque was not associated with any marker of femoral or tibial bone geometry. Further, while significant differences were observed between female (0.883 ± 0.31 Nm/kg) and male (1.18 ± 0.35 Nm/kg) patients regarding preoperative normalized knee flexion torque (p < 0.001), no significant sex differences were found for percentage increases in normalized knee flexion torque from presurgery to postsurgery. Generally, female patients demonstrated significantly higher MPTS magnitudes (p < 0.05) and lower LFCI values (p < 0.05) compared to men.
The present results demonstrated no association between tibial or femoral bone geometry and muscle strength of the hamstrings in patients with ACL reconstruction, indicating an important mismatch of muscular compensation to deviations in bone geometry. There were no sex-specific differences in tibiofemoral bone parameters.
Level III.
先前的证据表明，胫骨股骨骨结构可能会增加前交叉韧带（ACL）损伤的风险。此外，腘绳肌与四头肌的肌肉比例较低会使女性更容易出现不利的膝关节运动学。本研究的主要目的是研究原发性 ACL 损伤后继发 ACL 重建患者的胫骨股骨骨几何形状与等速膝关节屈曲扭矩之间的性别特异性关联。
分析了 100 例（72 例男性，28 例女性，年龄 31.3±10.2 岁，体重指数 25.3±3.6）原发性 ACL 断裂患者的前瞻性研究数据，这些患者在 ACL 重建手术后 6 个月进行了等速膝关节屈曲扭矩评估。对磁共振成像扫描进行内侧后胫骨斜率（MPTS）和外侧后胫骨斜率、切迹宽度指数（NWI）和外侧股骨髁指数（LFCI）分析。此外，评估了等速膝关节屈曲扭矩（60°/s）和腘绳肌-四头肌比值。随后，对性别亚组的功能参数与影像学数据进行了相关性分析。
研究结果表明，术前等速膝关节屈曲扭矩与股骨或胫骨骨几何形状的任何标志物均无相关性。此外，尽管女性（0.883±0.31 Nm/kg）和男性（1.18±0.35 Nm/kg）患者的术前膝关节屈曲扭矩的标准化值之间存在显著差异（p<0.001），但从术前到术后膝关节屈曲扭矩的标准化值的增加百分比在性别之间没有显著差异。一般来说，与男性相比，女性患者的 MPTS 幅度显著更高（p<0.05），LFCI 值显著更低（p<0.05）。
本研究结果表明，在接受 ACL 重建的患者中，胫骨或股骨骨几何形状与 ACL 重建患者的腘绳肌肌肉力量之间没有关联，这表明肌肉代偿与骨几何形状的偏差之间存在重要的不匹配。胫骨股骨骨参数在性别之间没有差异。
III 级。
