Can altered neuromuscular coordination restore soft tissue loading patterns in anterior cruciate ligament and menisci deficient knees during walking?
Can altered neuromuscular coordination restore soft tissue loading patterns in anterior cruciate ligament and menisci deficient knees during walking?
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DOI：
10.1016/j.jbiomech.2018.10.008
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发表时间：
2019-01-03
影响因子：
2.4
通讯作者：
Thelen, Darryl G.
中科院分区：
文献类型：
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作者：
Smith, Colin R.;Brandon, Scott C. E.;Thelen, Darryl G.
前十字韧带(ACL)和半月板的损伤通常会导致早期骨性关节炎。能够恢复正常软骨负荷模式的治疗可能会降低骨关节炎的风险，尽管目前还不清楚这样的目标是否可以通过保守的康复来实现。我们使用肌肉骨骼模拟来预测在完整、前交叉韧带缺陷、半月板缺陷和前交叉韧带-半月板缺陷膝关节行走时软骨和韧带的负荷模式。然后使用不同协调策略的随机模拟来测试在病理条件下是否可以调节神经肌肉控制来恢复正常的膝关节力学。在早期站立时，预测前交叉韧带缺陷的膝关节胫骨前移增加3 mm。在半月板缺乏的膝关节，内侧和外侧平台上的平均软骨接触压力分别增加了18%和24%。无论是前交叉韧带或半月板缺陷的膝关节，神经肌肉协调的变化都不足以恢复正常的软骨接触模式。在病理性膝关节中观察到软骨接触压力升高的区域，此前已有软骨磨损模式的报道。这些结果表明，步态过程中软骨组织负荷的改变可能有助于特定区域的退变模式，而孤立地改变神经肌肉协调不太可能恢复正常的膝关节力学。(C)爱思唯尔有限公司出版的2018年。
Injuries to the anterior cruciate ligament (ACL) and menisci commonly lead to early onset osteoarthritis. Treatments that can restore normative cartilage loading patterns may mitigate the risk of osteoarthritis, though it is unclear whether such a goal is achievable through conservative rehabilitation. We used musculoskeletal simulation to predict cartilage and ligament loading patterns during walking in intact, ACL deficient, menisci deficient, and ACL-menisci deficient knees. Stochastic simulations with varying coordination strategies were then used to test whether neuromuscular control could be modulated to restore normative knee mechanics in the pathologic conditions. During early stance, a 3 mm increase in anterior tibial translation was predicted in the ACL deficient knee. Mean cartilage contact pressure increased by 18% and 24% on the medial and lateral plateaus, respectively, in the menisci deficient knee. Variations in neuromuscular coordination were insufficient to restore normative cartilage contact patterns in either the ACL or menisci deficient knees. Elevated cartilage contact pressures in the pathologic knees were observed in regions where cartilage wear patterns have previously been reported. These results suggest that altered cartilage tissue loading during gait may contribute to region-specific degeneration patterns, and that varying neuromuscular coordination in isolation is unlikely to restore normative knee mechanics. (C) 2018 Published by Elsevier Ltd.