Alterations in three-dimensional joint kinematics of anterior cruciate ligament-deficient and -reconstructed knees during walking
Alterations in three-dimensional joint kinematics of anterior cruciate ligament-deficient and -reconstructed knees during walking
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DOI：
10.1016/j.clinbiomech.2009.11.006
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发表时间：
2010-03-01
影响因子：
1.8
通讯作者：
Zheng, Naiquan (Nigel)
中科院分区：
文献类型：
--
作者：
Gao, Bo;Zheng, Naiquan (Nigel)
背景：临床上观察到前交叉韧带(Acl)缺乏的膝关节存在高风险的软骨退变和过早的骨性关节炎发生。即使在前交叉韧带重建手术后，风险也没有显著降低。假设前交叉韧带损伤后膝关节三维运动学发生了改变，重建术后的生物力学改变并未完全恢复到正常水平。方法：在水平行走过程中，对前交叉韧带缺陷、前交叉韧带重建和前交叉韧带完整的膝关节的三维旋转和平移进行测量。对前交叉韧带缺陷和前交叉韧带完整的膝关节以及前交叉韧带重建和前交叉韧带完整的膝关节之间的变量进行比较。结果：在前交叉韧带缺陷和前交叉韧带重建的受试者中，都观察到了步态周期中时空变量和关键事件时间的变化。在站立中期前交叉韧带缺陷的膝关节和摆动阶段前交叉韧带重建的膝关节中观察到伸展的显著减少。在前交叉韧带缺陷的膝关节中发现了更大的内翻和胫骨内部旋转。虽然幅度较小，但这些继发性运动学改变在整个步态周期中是一致的，而且这种趋势在前交叉韧带重建的膝关节中并未消除。解释：在前交叉韧带缺陷的膝关节中，发现行走过程中时空表现和三维关节运动学的显著异常。前交叉韧带重建的膝关节在关节运动学方面有一定的改善，但并未完全恢复到正常水平。明确前交叉韧带损伤和重建膝关节在日常活动过程中的生物力学变化，有助于更好地了解临床结果，寻求改进前交叉韧带损伤治疗的手术技术和康复方案。爱思唯尔有限公司出版。
Background: High risk of cartilage degeneration and premature osteoarthritis development has been clinically observed in anterior cruciate ligament (ACL) deficient knees. The risk has not been significantly reduced even after ACL reconstructive surgery. It was hypothesized that three-dimensional knee joint kinematics has been altered after ACL injury, and the biomechanical alteration has not been fully restored to a normal level after reconstructive surgery.Methods: Spatiotemporal parameters and three-dimensional knee joint rotations and translations were measured in ACL-deficient, ACL-reconstructed, and ACL-intact knees during level walking. The variables were compared between the ACL-deficient and ACL-intact knees, as well as between the ACL-reconstructed and ACL-intact knees.Findings: Altered spatiotemporal variables and key event timings in a gait cycle were observed in both ACL-deficient and ACL-reconstructed subjects. Significant reduction of extension was observed in the ACL-deficient knees during midstance and in the ACL-reconstructed knees during swing phase. Greater varus and internal tibial rotation were identified in the ACL-deficient knees. Although being small in magnitude, these secondary kinematic alterations were consistent throughout the whole gait cycle, and such trends were not eliminated in the ACL-reconstructed knees.Interpretation: Significant abnormalities of spatiotemporal performance and three-dimensional joint kinematics during walking were identified in the ACL-deficient knees. The ACL-reconstructed knees exhibited some improvement in joint kinematics, but not being fully restored to a normal level. Identification of biomechanical alterations during daily activities in ACL-deficient and ACL-reconstructed knees could help better understand clinical outcomes and seek improvement in surgical technique and rehabilitation regimen for ACL injury treatment. Published by Elsevier Ltd.