目的:早期关节软骨损伤(CL)是前交叉韧带缺陷(ACLD)患者创伤后膝骨关节炎(PTOA)发病的重要标志。研究人员认为,改变运动学可以加速CLs,因此,导致PTOA的发作。然而,关于是否存在导致慢性ACLD膝关节早期CL的特定膝关节运动学知之甚少。水平行走是体内最频繁和最相关的活动,这极大地影响了膝盖的健康。我们假设,患有早期胫骨股CL的慢性ACLD膝盖在水平行走过程中的膝关节运动学与没有早期胫骨股CL的慢性ACLD膝盖的膝关节运动学存在显着差异。
方法:30例有慢性ACLD病史的患者,包括18个有CLs的受试者和12个没有CLs的受试者,从2020年7月至2022年8月,招募了35名健康对照受试者。使用三维运动分析系统收集了水平行走过程中的膝盖运动学数据。使用单向方差分析的一维统计参数映射比较了组间的运动学差异。通过MRI检查评估ACLD膝关节的软骨状态。使用改良的Noyes量表评估受试者的CLs分布,并通过卡方检验进行分析。
结果:带有CLs的ACLD膝盖胫骨后平移明显更大(7.7-8.0mm,12%-18%步态周期GC,p=0.014)与水平行走期间没有CLs的ACLD膝盖相比。具有CLs的ACLD膝盖胫骨后平移较大(4.6-5.5mm,0%-23%GC,p<0.001;5.8-8.0mm,86%-100%GC,p<0.001)在水平行走期间比健康对照组高。在带有CLs的ACLD膝盖组中,CL主要位于胫骨平台后部和股骨内侧髁承重区前部(p<0.05)。
结论:与没有软骨损伤的前交叉韧带不足的膝关节和健康受试者相比,慢性前交叉韧带不足的膝关节有软骨损伤的胫骨后平移增加。胫骨后平移可能在ACLD膝关节软骨退变中起重要作用。胫骨后平移和软骨损伤特征的增加可能会提高我们对膝关节运动学在软骨退化中的作用的理解,并且可能是前交叉韧带缺乏治疗的有用潜在参考。如体能训练,以改善异常的运动行为。
OBJECTIVE: Early articular cartilage lesion (CL) is a vital sign in the onset of posttraumatic knee osteoarthritis (PTOA) in patients with anterior cruciate ligament deficiency (ACLD). Researchers have suggested that altered kinematics could accelerate CLs and, therefore, lead to the onset of PTOA. However, little is known about whether specific knee kinematics exist that lead to early CL in chronic ACLD knees. Level walking is the most frequent and relevant in vivo activity, which greatly impacts knee health. We hypothesized that the knee kinematics during level walking in chronic ACLD knees with early tibiofemoral CL would significantly differ from those of chronic ACLD knees without early tibiofemoral CL.
METHODS: Thirty patients with a chronic ACLD history, including 18 subjects with CLs and 12 subjects without CLs, and 35 healthy control subjects were recruited for the study from July 2020 to August 2022. The knee kinematic data during level walking were collected using a three-dimensional motion analysis system. The kinematic differences between groups were compared using statistical parametric mapping with one dimension for One-Way ANOVA. The cartilage statuses of the ACLD knees were assessed via MRI examination. The CLs distribution of subjects was evaluated using a modified Noyes scale and analyzed by chi-square tests.
RESULTS: ACLD knees with CLs had significantly greater posterior tibial translation (7.7-8.0mm, 12%-18% gait cycle GC, p = 0.014) compared to ACLD knees without CLs during level walking. ACLD knees with CLs had greater posterior tibial translation (4.6-5.5mm, 0%-23% GC, p < 0.001; 5.8-8.0mm, 86%-100% GC, p < 0.001) than healthy controls during level walking. In the group of ACLD knees with CLs, CL is mainly located in the back of the tibia plateau and front of load bearing area of the medial femoral condyle (p < 0.05).
CONCLUSIONS: Chronic anterior cruciate ligament deficient knees with cartilage lesions have increased posterior tibial translation compared to anterior cruciate ligament deficient knees without cartilage lesions and healthy subjects. The posterior tibial translation may play an important role in knee cartilage degeneration in ACLD knees. The increased posterior tibial translation and cartilage lesion characteristics may improve our understanding of the role of knee kinematics in cartilage degeneration and could be a helpful potential reference for anterior cruciate ligament deficient therapy, such as physical training to improve abnormal kinematic behavior.