Anterior cruciate ligament deficiency combined with lateral and/or medial meniscal injury results in abnormal kinematics and kinetics during level walking
Anterior cruciate ligament deficiency combined with lateral and/or medial meniscal injury results in abnormal kinematics and kinetics during level walking
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前十字韧带缺损合并外侧和/或内侧半月板损伤导致水平行走时运动学和动力学异常
DOI：
10.1177/0954411919886763
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发表时间：
2019-11-12
期刊：
影响因子：
1.8
通讯作者：
Ao, Yingfang
中科院分区：
文献类型：
--
作者：
Liu, Xiaode;Huang, Hongshi;Ao, Yingfang
前交叉韧带损伤通常合并踝关节撕裂。本研究旨在分析前交叉韧带损伤伴或不伴内侧或/和外侧踝关节损伤的膝关节在水平行走时的运动学和动力学。共招募了29名单侧前交叉韧带缺损患者和15名健康男性志愿者。其中单纯单侧前交叉韧带损伤12例（ACLD组），前交叉韧带合并外侧踝关节损伤5例（ACLDL组），前交叉韧带合并内侧踝关节损伤5例（ACLDDM组），前交叉韧带合并内侧/外侧踝关节损伤7例（ACLDML组）。基于光学跟踪系统测量的实验数据，建立了一个特定于受试者的肌肉骨骼多体动力学模型，对胫股关节的运动学和动力学行为进行了估计。无论是否存在踝关节损伤，在站立末期，前交叉韧带缺损的膝关节的伸展度明显低于对照组（伸展范围：ACLD，4.84° ± 4.31°; ACLDL，6.65° ± 5.73°; ACLDDM，5.21° ± 4.77°; ACLDML，6.91° ± 4.30°;对照组，12.35° ± 5.52°; P < 0.05）。前交叉韧带损伤组膝关节在站立末期的伸展力矩和内收力矩均低于对照组（P < 0.05）。与其他4组相比，ACLDML组显示出显著更低的近端-远端压缩力和前后剪切力（约0.5-1.5体重; P < 0.05），而ACLD、ACLDL和ACLDM组的前后和内外侧剪切力在中期至末期站立时有增加的趋势。在ACLDML组中观察到显著较低的内收-外展和内外力矩峰值，但在ACLD、ACLDL和ACLDM组中未观察到。这些结果表明，前交叉韧带损伤和踝关节损伤的组合可以改变前交叉韧带缺损影响膝关节的运动学和动力学，这取决于踝关节撕裂的存在和类型。
Anterior cruciate ligament injuries are commonly combined with meniscal tears. This study was performed to analyze the kinematics and kinetics of knees with anterior cruciate ligament deficiency with or without a combined medial or/and lateral meniscal injury during level walking. In all, 29 patients with unilateral anterior cruciate ligament deficiency and 15 healthy male volunteers were recruited. Among these patients, 12 had isolated unilateral anterior cruciate ligament injuries (ACLD group), 5 had combined anterior cruciate ligament and lateral meniscal injuries (ACLDL group), 5 had combined anterior cruciate ligament and medial meniscal injuries (ACLDM group), and 7 had combined anterior cruciate ligament and medial/lateral meniscal injuries (ACLDML group). A subject-specific musculoskeletal multibody dynamics model was utilized to estimate the tibiofemoral joint kinematic and kinetic behaviors based on the experimental data measured by using an optical tracking system. Regardless of the presence or absence of meniscal injury, the knees with anterior cruciate ligament deficiency exhibited significantly less extension than the control knees at the terminal stance (range of extension: ACLD, 4.84° ± 4.31°; ACLDL, 6.65° ± 5.73°; ACLDM, 5.21° ± 4.77°; ACLDML, 6.91° ± 4.30°; control, 12.35° ± 5.52°; P < 0.05). A lower extension moment and adduction moment in all anterior cruciate ligament deficiency affected knees were detected during the terminal stance when compared with control knees (P < 0.05). The ACLDML group showed significantly lower proximal-distal compressive forces and anterior-posterior shear forces (approximately 0.5–1.5 body weight; P < 0.05) compared to the other 4 groups, while the anterior-posterior and medial-lateral shear forces tended to increase in the ACLD, ACLDL, and ACLDM groups at the mid to terminal stance. Significant lower adduction-abduction and internal-external moment peaks were observed in ACLDML groups, but not in the ACLD, ACLDL and ACLDM groups. These results indicate that the combination of an anterior cruciate ligament injury and meniscal injury could alter the kinematics and kinetics of anterior cruciate ligament deficiency affected knees depending on the presence and type of the meniscal tear.