Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Auf der Schmelz 6a (USZ II), 1150, Vienna, Austria.
Sci Rep. 2024 Nov 18;14(1):28520. doi: 10.1038/s41598-024-79021-x.
Patellofemoral instability is influenced by morphological factors and associated with compensational alterations in gait pattern. Recent simulation studies investigated the impact of knee morphology on the stability and loading of the patellofemoral joint but neglected the patient-specific gait pattern. The aim of this study was to investigate the impact of patient-specific gait pattern on muscle forces and joint loading in individuals with patellofemoral instability. Musculoskeletal simulations with a model including a twelve degrees of freedom knee joint were performed based on three-dimensional motion capture data of 21 individuals with chronic patellofemoral instability and 17 healthy control participants. The patellofemoral instability group walked with a less flexed knee joint and reduced knee flexion and abduction moments compared to the control group, which required less quadriceps muscle forces. Lower quadriceps muscle forces resulted in a reduction of tibiofemoral and patellofemoral joint contact forces despite similar walking velocities between both groups. Furthermore, we observed decreased lateralizing patella forces in subjects with patella instability, which could potentially reduce the risk of patella dislocation. Our findings highlight the importance of accounting for the patient-specific gait pattern when analysing knee loads in individuals with patellofemoral instability.
髌股关节不稳定受形态因素影响，并与步态模式的代偿性改变有关。最近的模拟研究调查了膝关节形态对髌股关节稳定性和负荷的影响，但忽略了患者特定的步态模式。本研究旨在研究患者特定的步态模式对髌股关节不稳定患者肌肉力量和关节负荷的影响。基于 21 名慢性髌股关节不稳定患者和 17 名健康对照组的三维运动捕捉数据，使用包括十二自由度膝关节模型的肌肉骨骼模拟进行了研究。与对照组相比，髌股关节不稳定组的膝关节弯曲度较小，膝关节弯曲和外展力矩减小，这需要较少的股四头肌力量。较低的股四头肌力量导致胫股关节和髌股关节接触力减小，尽管两组的步行速度相似。此外，我们观察到髌股关节不稳定患者的髌骨外侧化力量减小，这可能降低髌骨脱位的风险。我们的研究结果强调了在分析髌股关节不稳定患者膝关节负荷时考虑患者特定的步态模式的重要性。
