Meniscus Injuries Alter the Kinematics of Knees With Anterior Cruciate Ligament Deficiency.
Meniscus Injuries Alter the Kinematics of Knees With Anterior Cruciate Ligament Deficiency.
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DOI：
10.1177/2325967114547346
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发表时间：
2014-08
影响因子：
2.6
通讯作者：
Li G
中科院分区：
文献类型：
--
作者：
Hosseini A;Li JS;Gill TJ 4th;Li G
大多数膝关节生物力学研究都涉及孤立性前交叉韧带（ACL）损伤的膝关节。然而，很大一部分前交叉韧带损伤患者伴有半月板撕裂。在这项研究中，研究了在爬楼梯活动中撕裂前交叉韧带（ACL）合并或不合并内侧或外侧半月板撕裂后膝关节生物力学的体内变化。膝关节缺乏acl的运动学行为随着内侧或外侧半月板撕裂而改变。对照实验室研究。21例ACL损伤患者（对侧完整）在进行ACL重建前被招募。其中，单纯ACL损伤5例（ⅰ组），ACL与内侧半月板合并损伤8例（ⅱ组），ACL与外侧半月板合并损伤8例（ⅲ组）。对每位患者进行双侧磁共振扫描，建立三维解剖膝关节模型。然后在爬楼梯活动中使用双透视成像系统扫描双膝。采用骨模型图像匹配方法再现了爬楼梯时膝关节的运动学。然后比较受伤患者和完整患者的对侧膝关节在上楼梯时的前后外侧平移和胫骨轴向旋转。平均而言，I组和III组损伤的膝关节表现为胫骨前平移增加2 mm以上，接近膝关节完全伸展。在II组中，损伤侧与对侧的前后平移无统计学差异。在接近完全伸展的情况下，在I组和III组中，与对侧相比，损伤膝盖内侧胫骨移位增加不到1mm，而在II组中，损伤膝盖外侧胫骨移位增加1.0 mm。关于胫骨轴向旋转，I组胫骨外旋转增加（约5°），II组变化不大，而III组胫骨内旋转增加（约3°）。本研究的结果表明，与孤立的前交叉韧带撕裂相比，前交叉韧带/半月板联合损伤可能以不同的方式改变前交叉韧带损伤膝盖的运动学，这取决于半月板撕裂的模式。考虑到半月板损伤对膝关节运动学的不同影响，未来的研究可能会侧重于前交叉韧带和半月板合并损伤患者的具体治疗，以保护关节免受运动异常和随后的术后软骨退变。
Most knee joint biomechanics studies have involved knees with an isolated anterior cruciate ligament (ACL) injury. However, a large portion of patients with injured ACLs have accompanied meniscus tearing. In this study, the in vivo alteration of knee biomechanics after tearing the ACL with or without combined medial or lateral meniscus tear was investigated during stair-ascending activity. The kinematic behavior of ACL-deficient knees changes with a combined medial or lateral meniscus tear. Controlled laboratory study. Twenty-one patients with injured ACLs (contralateral side intact) were recruited before undergoing ACL reconstruction. Among these patients, 5 had isolated ACL injuries (group I), 8 had combined ACL and medial meniscus injuries (group II), and 8 had combined ACL and lateral meniscus injuries (group III). Bilateral magnetic resonance scans were obtained on each patient to construct 3-dimensional anatomic knee models. Both knees were then scanned during stair-climbing activity using a dual fluoroscopic imaging system. The knee kinematics during stair climbing were reproduced using a bone model image matching method. Anteroposterior and mediolateral translations and axial tibial rotation of the knee during stair ascent were then compared between the injured and intact contralateral knees of the patients. On average, injured knees in groups I and III showed more than 2 mm increased anterior tibial translation close to full knee extension. In group II, no statistically significant difference was observed between the injured and contralateral side in anteroposterior translation. Near full extension, in groups I and III, injured knees had less than 1 mm of increased medial tibial translation compared with the contralateral side, whereas in group II, a 1.0-mm increase in lateral tibial shift was observed in the injured knees. With regard to axial tibial rotation, group I showed an increased external tibial rotation (approximately 5°), group II had little variation, whereas group III had increased internal tibial rotation (approximately 3°). The results of this study demonstrate that a combined ACL/meniscus injury could alter the kinematics of ACL-injured knees in a different way compared with knees with isolated ACL tears, depending on the pattern of the meniscus tear. Considering the varying effect of meniscus injuries on knee joint kinematics, future studies might focus on specific treatment of patients with combined ACL and meniscus injuries to protect the joint from abnormal kinematics and subsequent postoperative cartilage degeneration.