Pandy Marcus G, Gray Hans A, Ganapam Padma N, Culvenor Adam G, Crossley Kay M, Guan Shanyuanye
Department of Mechanical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia.
J Orthop Res. 2025 May;43(5):1024-1034. doi: 10.1002/jor.26062. Epub 2025 Mar 19.
Accurate measurements of knee joint motion during gait after anterior cruciate ligament reconstruction (ACLR), especially for the patellofemoral joint, are sparse. The aim of this study was to measure six-degree-of-freedom (6-DOF) patellofemoral and tibiofemoral motion in ACLR and uninjured contralateral knees during gait, and to compare these results to healthy (control) knees. Biplane fluoroscopy was used to measure 6-DOF patellofemoral and tibiofemoral motion in 15 ACLR participants (26.3 ± 3.9 years) for complete cycles of level walking and downhill walking, and the results were compared to data for 10 healthy individuals (29.8 ± 6.1 years). Mean patellar superior translation, anterior translation, and flexion over the gait cycle were respectively 4.4-5.6 mm greater, 5.4-6.3 mm greater, and 3.7°-7.0° less in the ACLR and contralateral knees compared to controls across both activities (p < 0.021). Articular contact was 7.6 mm higher on the femoral trochlea in the ACLR and contralateral knees compared to controls. The patellar tendon was 8.9 mm longer (p < 0.001) in the ACLR and contralateral knees compared to controls. Among ACLR participants, 14 out of 30 knees (47%) had an Insall-Salvati ratio ≥ 1.20, indicating patella alta. Mean tibial external rotation and anterior translation over the gait cycle were respectively 3.4°-3.8° greater and 2.6-3.0 mm greater in the ACLR knee compared to controls across both activities (p < 0.025). A high-riding patella in both knees of the ACLR participants was due to a longer patellar tendon. A change in the load-bearing areas of the femoral trochlea may contribute to the high rate of patellofemoral osteoarthritis seen after ACLR.
在前交叉韧带重建（ACLR）术后步态期间对膝关节运动进行准确测量，尤其是对髌股关节的测量，数据较为匮乏。本研究的目的是测量ACLR膝关节和未受伤的对侧膝关节在步态期间的六自由度（6-DOF）髌股关节和胫股关节运动，并将这些结果与健康（对照）膝关节进行比较。使用双平面荧光透视法测量了15名ACLR参与者（26.3±3.9岁）在平路行走和下坡行走完整周期中的6-DOF髌股关节和胫股关节运动，并将结果与10名健康个体（29.8±6.1岁）的数据进行比较。与对照组相比，在两项活动中，ACLR膝关节和对侧膝关节在步态周期中的平均髌骨上移、前移和屈曲分别大4.4 - 5.6毫米、5.4 - 6.3毫米和小3.7° - 7.0°（p < 0.021）。与对照组相比，ACLR膝关节和对侧膝关节在股骨滑车处的关节接触高7.6毫米。与对照组相比，ACLR膝关节和对侧膝关节的髌腱长8.9毫米（p < 0.001）。在ACLR参与者中，30个膝关节中有14个（47%）的Insall-Salvati比率≥1.20，表明髌骨高位。与对照组相比，在两项活动中，ACLR膝关节在步态周期中的平均胫骨外旋和前移分别大3.4° - 3.8°和2.6 - 3.0毫米（p < 0.025）。ACLR参与者双膝髌骨高位是由于髌腱较长。股骨滑车承重区域的变化可能导致ACLR术后髌股关节炎的高发生率。
