Cottmeyer Daniel F, Lyle Mark A, Sims Macie M, Xerogeanes John W, Tsai Liang-Ching
Department of Physical Therapy, Georgia State University, Atlanta, GA, USA.
Division of Physical Therapy, Emory University, Atlanta, GA, USA.
J Appl Biomech. 2025 Apr 21;41(4):304-312. doi: 10.1123/jab.2024-0159. Print 2025 Aug 1.
A higher risk of knee osteoarthritis (OA) has been identified in patients with slower walking speeds following anterior cruciate ligament reconstruction (ACLR). Given that altered loading of the surgical knee has been the most proposed mechanism for early knee OA post-ACLR, understanding how modulating walking speed may modify knee joint loading is essential for developing strategies to reduce the risk of knee OA in ACLR patients. The purpose of this study was to determine how modulation of walking speed affects knee joint loading during overground walking post-ACLR. Lower extremity kinematics and kinetics were recorded during overground walking at a self-selected, slower, and faster speed from 16 patients with unilateral ACLR. The results showed that ACLR patients demonstrated lesser peak knee flexion and adduction moments of the surgical knees when walking at slower speeds. However, modulating walking speed did not alter between-limb knee loading asymmetry. The ACLR limbs had lower peak knee flexion moments than the uninjured limbs across all 3 walking speeds. Although interventions that increase walking speed may deter the onset of knee OA by elevating the mechanical stimulation at the surgical knee, additional gait training strategies may be needed to restore the between-limb loading symmetry in ACLR patients.
在前交叉韧带重建术（ACLR）后步行速度较慢的患者中，已发现患膝关节骨关节炎（OA）的风险更高。鉴于手术膝关节负荷改变是ACLR后早期膝关节OA最常被提出的机制，了解调节步行速度如何改变膝关节负荷对于制定降低ACLR患者膝关节OA风险的策略至关重要。本研究的目的是确定步行速度的调节如何影响ACLR后地面行走时的膝关节负荷。记录了16名单侧ACLR患者以自选、较慢和较快速度地面行走时的下肢运动学和动力学数据。结果表明，ACLR患者在较慢速度行走时，手术侧膝关节的屈膝峰值和内收力矩较小。然而，调节步行速度并未改变双侧膝关节负荷的不对称性。在所有三种步行速度下，ACLR侧肢体的屈膝峰值力矩均低于未受伤侧肢体。尽管提高步行速度的干预措施可能通过增加手术侧膝关节的机械刺激来延缓膝关节OA的发生，但可能还需要额外的步态训练策略来恢复ACLR患者双侧肢体的负荷对称性。
