Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury.
Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury.
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DOI：
10.1177/0363546515608475
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发表时间：
2016-01
期刊：
影响因子：
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通讯作者：
Snyder-Mackler L
中科院分区：
文献类型：
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作者：
Wellsandt E;Gardinier ES;Manal K;Axe MJ;Buchanan TS;Snyder-Mackler L
前交叉韧带（ACL）损伤易使个体发生早发性膝关节骨关节炎（OA）。ACL损伤和重建后关节负荷异常明显。关节生物力学改变与膝关节OA发展之间的关系尚不清楚。损伤和重建后最初改变的膝关节动力学和内侧间室接触力与重建后5年的影像学膝关节OA相关。病例对照研究;证据等级，3。急性单侧ACL损伤患者在术前康复前（基线）和术后（训练后）以及重建后6个月、1年和2年完成步态分析。表面肌电和膝关节生物力学数据作为肌电驱动的肌肉骨骼模型的输入，以估计膝关节接触力。患者在重建后5年完成影像学检查。比较了有和无影像学膝关节OA患者之间膝关节动力学和接触力的差异。基线时，OA患者的额面肢体间差异大于无OA患者（非OA）（峰值膝关节内收力矩差：0.00 ± 0.08 N·m/kg·m [非OA] vs −0.15 ± 0.09 N·m/kg·m [OA]，P = 0.014;峰值膝关节内收力矩脉冲差：−0.001 ± 0.032 N·m·s/kg·m [非骨关节炎] vs −0.048 ± 0.031 N·m·s/kg·m [骨关节炎]，P = 0.042）。基线时，骨关节炎组的受累肢体膝关节内收力矩冲量也低于无骨关节炎组（0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA]，P = 0.023）。训练后组间差异不显著，但重建后6个月再次出现（膝关节内收力矩峰值差：0.02 ± 0.04 N·m/kg·m [非OA] vs −0.06 ± 0.11 N·m/kg·m [OA]，P = 0.043）。此外，在6个月时，OA组患肢内侧间室接触力峰值低于无OA组（2.89 ± 0.52体重[非OA] vs 2.10 ± 0.69体重[OA]，P = 0.036）。ACL重建术后5年有膝关节影像学OA的患者，其膝关节内收力矩和内侧间室关节接触力低于损伤和重建后早期无OA的患者。
Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. Case-control study; Level of evidence, 3. Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs −0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: −0.001 ± 0.032 N·m·s/kg·m [nonOA] vs −0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs −0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036). Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction.