Bühl Linda, Müller Sebastian, Nüesch Corina, Halbeisen Florian Samuel, Mündermann Annegret, Egloff Christian
Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
Neuroorthopaedics and Centre for Clinical Motion Analysis, University Children's Hospital Basel (UKBB), Basel, Switzerland.
Orthop J Sports Med. 2025 Jul 25;13(7):23259671251358386. doi: 10.1177/23259671251358386. eCollection 2025 Jul.
InternalBrace-augmented anterior cruciate ligament repair (ACL-IB) is believed to restore natural knee mechanics. However, there is a dearth of data on in vivo leg biomechanics after ACL-IB and comparability with gold standard surgery.
To (1) investigate differences in sagittal and frontal landing biomechanics of the legs in patients after ACL-IB (Comparison I) and after anterior cruciate ligament reconstruction (ACLR; Comparison II), compare the involved legs with controls (Comparison III), and (2) identify leg differences that were greater than those typically observed in controls.
Cross-sectional study, Level of Evidence 3.
A total of 29 patients who had ACL-IB, 27 sex- and age-matched patients who had ACLR, and 29 matched controls were asked to perform single-leg hops (SLH) for maximum forward distance 2 years postoperatively, assessed by marker-based motion analysis. Sagittal (hip, knee, and ankle) and frontal (hip and knee) plane angles and peak moments, joint work contribution, and peak vertical ground-reaction force and loading rates during landing were calculated. Differences between the involved and uninvolved legs in patients (paired tests) and between the involved legs in patients and the nondominant legs in controls (1-way analysis of variance) were analyzed. To determine whether these differences exceeded the typical variation seen in the control legs, we compared the overlap of the 95% CIs of the differences with the 95% CIs of the within-control differences (the nondominant versus dominant leg).
Patients who underwent ACL-IB (ACL-IB group) and ACLR (ACLR group) showed significant differences in their legs' SLH landing biomechanics. Only leg differences in the ACL-IB group were greater than those in in the control group (no overlap): smaller peak knee flexion angle (leg difference: -8.3° [95% CI, -13 to -3.7]; = -0.85; = .001; controls [95% CI, -1.7 to 4.2]) and lower peak knee flexion moment (-0.60 Nm/kg [95% CI, -0.72 to -0.31]; = -0.72; < .001; controls [95% CI, -0.06 to 0.35]) in the involved compared with the uninvolved leg; and lower peak knee flexion moment in the involved leg compared with control legs (-0.50 Nm/kg [95% CI, -1 to -0.07]; = -0.71; = .020).
Persistent differences in SLH landing biomechanics 2 years after ACL surgery suggest that ACL ruptures cause alterations that cannot be restored by augmented repair or reconstruction alone. The greater differences between the legs in the ACL-IB group than those typically seen within controls highlight the need for further research to understand the full potential or limitation of ACL preservation techniques.
内置支撑增强前交叉韧带修复术（ACL-IB）被认为可恢复膝关节的自然力学。然而，关于ACL-IB术后体内腿部生物力学以及与金标准手术的可比性的数据却很匮乏。
（1）研究ACL-IB术后（比较一）和前交叉韧带重建术后（ACLR；比较二）患者腿部矢状面和额状面着地生物力学的差异，将患侧腿与对照组进行比较（比较三），（2）确定大于对照组通常观察到差异的腿部差异。
横断面研究，证据水平3。
共有29例行ACL-IB的患者、27例年龄和性别匹配的行ACLR的患者以及29例匹配的对照组被要求在术后2年进行单腿跳跃（SLH）以达到最大向前距离，通过基于标记的运动分析进行评估。计算矢状面（髋、膝和踝）和额状面（髋和膝）平面角度、峰值力矩、关节功贡献以及着地时的峰值垂直地面反作用力和加载率。分析患者患侧腿与未患侧腿之间的差异（配对检验）以及患者患侧腿与对照组非优势腿之间的差异（单因素方差分析）。为了确定这些差异是否超过对照组腿部的典型变异，我们将差异的95%置信区间与对照组内差异（非优势腿与优势腿）的95%置信区间进行了重叠比较。
接受ACL-IB（ACL-IB组）和ACLR（ACLR组）的患者在腿部SLH着地生物力学方面存在显著差异。只有ACL-IB组的腿部差异大于对照组（无重叠）：患侧腿的峰值屈膝角度较小（腿部差异：-8.3°[95%置信区间，-13至-3.7]；t = -0.85；P = 0.001；对照组[95%置信区间，-1.7至4.2]），峰值屈膝力矩较低（-0.60 Nm/kg[95%置信区间，-0.72至-0.31]；t = -0.72；P < 0.001；对照组[95%置信区间，-0.06至0.35]）；与对照组腿部相比，患侧腿的峰值屈膝力矩较低（-0.50 Nm/kg[95%置信区间，-1至-0.07]；t = -0.71；P = 0.020）。
ACL手术后2年单腿跳跃着地生物力学存在持续差异，表明ACL断裂会导致一些改变，仅通过增强修复或重建无法恢复。ACL-IB组腿部之间的差异大于对照组通常观察到的差异，这凸显了进一步研究以了解ACL保留技术的全部潜力或局限性的必要性。
