Wexler G, Hurwitz D E, Bush-Joseph C A, Andriacchi T P, Bach B R
Department of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
Clin Orthop Relat Res. 1998 Mar(348):166-75.
Functional adaptations in knee kinematics and kinetics during level walking in 30 patients with unilateral anterior cruciate ligament deficiency and 30 healthy control subjects were studied. To examine the impact of time after injury on the functional adaptations, patients were placed into three time interval groups: early, intermediate, and chronic. The patients with anterior cruciate ligament deficiency had significantly decreased external knee flexion moments (balanced by net quadriceps contraction) and significantly increased external knee extension moments (balanced by net knee flexors contraction) as compared with the control subjects. As time after the injury increased, changes in the sagittal plane knee moments were more pronounced. A significant linear relationship (positive correlation) was found between the midstance knee flexion moment and the corresponding knee flexion angle. The patients with anterior cruciate deficiency had a greater knee flexion angle when generating a comparable midstance knee flexion moment as compared to the control subjects. The identification of gait adaptations over time provides additional information on the natural history of anterior cruciate ligament deficiency and may have implications regarding conservative rehabilitation, evaluation of outcomes, progression of meniscal injury, and the development of degenerative arthritis of the knee.
对30名单侧前交叉韧带损伤患者和30名健康对照者在平地行走时膝关节运动学和动力学的功能适应性进行了研究。为了检验损伤后时间对功能适应性的影响，将患者分为三个时间间隔组：早期、中期和慢性期。与对照者相比，前交叉韧带损伤患者的膝关节外侧屈曲力矩显著降低（由股四头肌净收缩平衡），膝关节外侧伸展力矩显著增加（由膝关节屈肌净收缩平衡）。随着损伤后时间的增加，矢状面膝关节力矩的变化更为明显。在站立中期膝关节屈曲力矩与相应的膝关节屈曲角度之间发现了显著的线性关系（正相关）。与对照者相比，前交叉韧带损伤患者在产生可比的站立中期膝关节屈曲力矩时具有更大的膝关节屈曲角度。随着时间推移对步态适应性的识别为前交叉韧带损伤的自然史提供了额外信息，并且可能对保守康复、结果评估、半月板损伤进展以及膝关节退行性关节炎的发展具有影响。
