School of Exercise and Health, Shanghai University of Sport, Shanghai, China.
Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Orthop Surg Res. 2024 Nov 6;19(1):726. doi: 10.1186/s13018-024-05159-z.
Manipulation under anesthesia (MUA) has been recommended for refractory arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. However, the effectiveness of MUA to restore normal kinematics of the arthrofibrotic knee is still unclear. The objective of this study was to evaluate tibiofemoral and patellofemoral kinematics in six degrees-of-freedom (6DOF) in patients with arthrofibrosis before and after MUA.
Computed tomography and dual fluoroscopic imaging system were used to assess in vivo knee kinematics. Ten patients (6 women and 4 men; 32.6 ± 6.5y, 168.4 ± 7.8 cm, 61.8 ± 13.2 kg) were included in this study. The tibiofemoral and patellofemoral kinematics in 6DOF were collected before and one year after MUA. A simple analysis of variance was used to evaluate kinematic data of preoperative arthrofibrotic knee, postoperative arthrofibrotic knee, and the contralateral knee.
The patella in the postoperative arthrofibrotic knee shifted significantly more inferiorly compared to the preoperative knee at 45° (P = 0.010), 60° (P = 0.008), and 75° (P = 0.049) of flexion. The patellar flexion in the postoperative arthrofibrotic knee significantly increased at 45° (P = 0.048), 60° (P = 0.037), and 75° (P = 0.006) of flexion compared to the preoperative arthrofibrotic knee. The patellar tilt was significantly decreased at 60° (P = 0.006) and at 75° (P = 0.037) of knee flexion in the postoperative arthrofibrotic knee compared to the contralateral knee. MUA significantly increased tibial internal rotation angle in the arthrofibrotic knee at 45° (P = 0.047), at 60° (P = 0.033), and at 75° (P = 0.021) of knee flexion.
MUA could restore normal patellar inferior shift, flexion, and tibial rotation compared to the contralateral side. However, the MUA could not restore normal patellar tilt of the arthrofibrotic knee. This indicated that improvement of patellar tilt should be emphasized in postoperative rehabilitation.
关节镜下松解术（MUA）已被推荐用于前交叉韧带（ACL）重建后难治性关节纤维化。然而，MUA 恢复关节纤维化膝关节正常运动学的效果仍不清楚。本研究的目的是评估 MUA 前后关节纤维化膝关节的胫骨股骨和髌股关节六自由度（6DOF）运动学。
使用计算机断层扫描和双荧光透视成像系统评估膝关节的体内运动学。纳入 10 名患者（6 名女性和 4 名男性；32.6±6.5 岁，168.4±7.8cm，61.8±13.2kg）。在 MUA 前后收集胫骨股骨和髌股关节的 6DOF 运动学。采用简单方差分析评估术前、术后关节纤维化膝关节和对侧膝关节的运动学数据。
术后关节纤维化膝关节的髌骨在 45°（P=0.010）、60°（P=0.008）和 75°（P=0.049）屈曲时明显更向下移位。术后关节纤维化膝关节的髌骨屈曲在 45°（P=0.048）、60°（P=0.037）和 75°（P=0.006）时明显增加与术前关节纤维化膝关节相比。术后关节纤维化膝关节的髌骨倾斜在 60°（P=0.006）和 75°（P=0.037）时明显低于对侧膝关节的膝关节屈曲。与对侧膝关节相比，MUA 显著增加了关节纤维化膝关节的胫骨内旋角度在 45°（P=0.047）、60°（P=0.033）和 75°（P=0.021）的膝关节屈曲。
与对侧膝关节相比，MUA 可恢复正常的髌骨下移位、屈曲和胫骨旋转。然而，MUA 不能恢复关节纤维化膝关节的正常髌骨倾斜。这表明术后康复应强调改善髌骨倾斜。
