Three dimensional knee kinematics and kinetics in ACL-deficient patients with and without medial meniscus posterior horn tear during level walking
Three dimensional knee kinematics and kinetics in ACL-deficient patients with and without medial meniscus posterior horn tear during level walking
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DOI：
10.1016/j.gaitpost.2018.08.007
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发表时间：
2018-10-01
期刊：
影响因子：
2.4
通讯作者：
Ao, Yingfang
中科院分区：
文献类型：
--
作者：
Ren, Shuang;Yu, Yuanyuan;Ao, Yingfang
背景：据报道，半月板撕裂的位置会影响前交叉韧带缺陷（ACLD）膝关节的运动学。内侧半月板后角撕裂（MMPHT）常发生在前交叉韧带破裂后。MMPHT是否影响ACLD膝关节的运动学和动力学尚未见报道。研究问题：本研究的目的是研究有和没有MMPHT （ACLD+ MMPHT， ACLD）的ACLD膝关节在水平行走期间的三维（3D）运动学和动力学。方法：2014年1月至2016年12月，15例孤立性单侧ACLD患者、10例单侧ACLD+ MMPHT患者和22例健康对照者进行步态测试。比较对照组、ACLD组和ACLD+ MMPHT组的参与者特征和步态参数。结果：与健康对照组相比，有和没有MMPHT的ACLD膝关节在最大伸直（屈曲：ACLD: 7.83 +/- 4.3度，ACLD+ MMPHT: 11.09 +/- 7.8度，对照组：3.12 +/- 4.6度，p= 0.005）和末端站立阶段的下伸直力矩明显不足。与健康对照组相比，ACLD+ MMPHT组的膝关节在摆前阶段的胫骨外旋明显增加，在站立末期的旋转力矩明显降低，而ACLD组的膝关节则没有。在站立行走阶段，ACLD和ACLD+ MMPHT膝关节之间的步态参数无显著差异。意义：与健康对照膝关节相比，内侧半月板后角撕裂的ACLD膝关节在站立末期表现为伸展不足，胫骨外旋、下伸和内旋力矩增加，表现为“僵硬步态”和“支点移位步态”相结合的模式。与健康对照组相比，ACLDs患者的膝关节仅表现为伸直不足和伸直力矩较低，表现为“僵硬步态”。内侧半月板后角撕裂对ACLD患者站立行走时的步态模式无显著影响。
Background: The location of the meniscus tear has been reported to influence kinematics in anterior cruciate ligament deficient (ACLD) knees. Medial meniscus posterior horn tear (MMPHT) often occurred after ACL rupture. Whether MMPHT influences the kinematics and kinetics in ACLD knees has not been reported yet.Research question: The purpose of this study was to investigate three-dimensional (3D) kinematics and kinetics in ACLD knees with and without MMPHT (ACLD+ MMPHT, ACLDs) during level walking.Methods: Fifteen patients with isolated unilateral ACLD, ten with unilateral ACLD+ MMPHT, and twenty-two healthy controls underwent gait testing between January 2014 and December 2016. Participant characteristics, as well as gait parameters, were compared among control, ACLDs and ACLD+ MMPHT knees.Results: Compared to the healthy controls, the ACLD knees with and without MMPHT showed significant extension deficiency at maximum extension (flexion: ACLDs: 7.83 +/- 4.3 degrees, ACLD+ MMPHT: 11.09 +/- 7.8 degrees, control: 3.12 +/- 4.6 degrees, p= 0.005) and lower extension moments during terminal stance phase of gait. Compared with the healthy controls, significantly increased external tibial rotation during pre-swing phase and lower rotation moments at terminal stance phase were observed in the ACLD+ MMPHT knees, but not in the ACLDs knees. No significant differences in gait parameters were observed between ACLDs and ACLD+ MMPHT knees during stance phase of walking.Significance: The ACLD knees with medial meniscus posterior horn tear exhibited extension deficiency, increased external tibial rotation, lower extension and internal rotation moments during the terminal stance phase compared to healthy control knees, presenting a combination of "stiffening gait" and "pivot shift gait" pattern. The ACLDs knees only presented extension deficiency and lower extension moments compared with healthy control knees, presenting a "stiffening gait". Medial meniscus posterior horn tear did not significantly affect gait patterns during stance of walking in ACLD knees.