Decrease of knee flexion torque in patients with ACL reconstruction: combined analysis of the architecture and function of the knee flexor muscles
Decrease of knee flexion torque in patients with ACL reconstruction: combined analysis of the architecture and function of the knee flexor muscles
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DOI：
10.1007/s00167-005-0701-2
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发表时间：
2006-04-01
影响因子：
3.8
通讯作者：
Kanamori, A
中科院分区：
文献类型：
--
作者：
Makihara, Y;Nishino, A;Kanamori, A
据报道，使用半腱肌腱（和股薄肌腱）进行前交叉韧带 (ACL) 重建后，膝关节深度屈曲扭矩有所降低。然而，这种弱点的原因仍然存在争议。膝屈肌的结构和功能差异影响了这种弱点。直接测量了六具人体尸体的半腱肌、股薄肌、半膜肌和股二头肌的纤维长度。使用同侧半腱肌腱，在 ACL 重建后（术后 12-43 个月）测量 16 名患者（23 +/- 5 岁）的双肢腘绳肌的屈曲扭矩和肌电图。对这些患者的两条大腿进行磁共振成像，以测量肌肉体积并确认半腱肌腱的再生状态。还分析了半腱肌肌腱连接处的位置。半腱肌和股薄肌的纤维长度比半膜肌和股二头肌长三到四倍。随着膝关节屈曲角度的增大，正常肢体与ACL重建肢体之间的屈曲扭矩差异显着增大。双肢半膜肌、股二头肌以及ACL重建肢体半腱肌肌电图值随着膝关节屈曲角度的增大而显着降低。重建肢体的半腱肌体积明显小于正常肢体。所有受试者都证实了半腱肌腱的再生，并且几乎所有受试者的重建肢体的肌腱连接位置都在距离膝关节间隙比正常肢体更远的图像中被发现。 ACL重建后膝关节深屈曲扭矩的降低可能是由于半腱肌腱被切除后的萎缩和缩短，以及由于半腱肌与半膜肌和股二头肌之间的结构差异而导致半膜肌和股二头肌缺乏代偿。
A decrease of deep knee flexion torque after anterior cruciate ligament (ACL) reconstruction, using a semitendinosus (and gracilis) tendon, has been reported. However, the cause of this weakness remains controversial. Architectural and functional differences in the knee flexor muscles influence this weakness. the fiber length of the semitendinosus, gracilis, semimembranosus, and biceps femoris were directly measured in six human cadavers. The flexion torque and EMG of the hamstrings were measured in both limbs of 16 patients (23 +/- 5 years) after ACL reconstruction (12-43 months post-operation), using ipsilateral semitendinosus tendon. Magnetic resonance imagings were taken, over both the thighs of those patients, to measure muscle volume and to confirm a state of semitendinosus tendon regeneration. The position of the musculotendinous junction of the semitendinosus was also analyzed. The fiber length of the semitendinosus and gracilis were three to four times longer than that of the semimembranosus and biceps femoris. The difference of flexion torque between the normal and ACL reconstructed limbs significantly increased as the knee flexion angle increased. The EMG value for the semimembranosus and biceps femoris of both limbs as well as the semitendinosus of the ACL reconstructed limbs, significantly reduced as the knee flexion angle was increased. The volume of the semitendinosus in the reconstructed limb was significantly smaller than in normal limbs. The regeneration of the semitendinosus tendon was confirmed in all subjects, and the musculotendinous junction position of the reconstructed limb in almost all subjects was found in further image from the knee joint space than that for the normal limb. The decrease of deep knee flexion torque, after ACL reconstruction, could be due to the atrophy and shortening of the semitendinosus after its tendon has been harvested, as well as the lack of compensation from the semimembranosus and biceps femoris, due to the architectural differences between the semitendinosus and the semimembranosus and biceps femoris.