背景:关于增强ACL修复后的膝关节力学和肌肉控制知之甚少。我们的目的是比较InternalBraceTM增强前交叉韧带修复(ACL-IB)后2年患者与ACL-IB和ACL重建(ACL-R)后患者之间行走时的膝关节生物力学和腿部肌肉活动,和控制。
方法:29个ACL-IB,27个性别和年龄匹配的ACL-R(绳肌腱自体移植)和29个匹配的对照完成了仪器步态分析。膝关节角度,时刻,电源,在ACL-IB中比较受累和未受累的腿部肌肉活动(配对t检验),以及使用统计参数映射(SPM,P<0.05)。离散参数(DP;即,计算了最大值/最小值)。
结果:仅在最小膝关节屈曲角度(DP:2.4°,CI[-4.4;-0.5];涉及>未涉及)和站立时最大膝关节屈曲力矩(-0.07Nm/kg,CI[-0.13;-0.00];涉及<未涉及),和ACL-IB和ACL-R之间的差异仅在挥杆期间的最大膝关节屈曲(DP:3.6°,CI[0.5;7.0];ACL-IB>ACL-R)。与对照组相比,ACL-IB(SPM:0-3%GC,P=0.015;98-100%,P=0.016;DP:-6.3mm,CI[-11.7;-0.8])和ACL-R(DP:-6.0mm,CI[-11.4;-0.2])在脚跟撞击周围的胫骨前位置较低(最大)。ACL-R还具有较低的最大膝盖伸展力矩(DP:-0.13Nm/kg,CI[-0.23;-0.02])和内膝旋转力矩(SPM:34-41%GC,P<0.001;DP:-0.03Nm/kg,CI[-0.06;-0.00])站立时,和更大的最大半腱肌活动在脚跟前(DP:11.2%最大自愿收缩,CI[0.1;21.3])比对照。
结论:我们的结果表明,ACL-IB和ACL-R术后2年的动态膝关节功能相当,ACL-IB显示腿之间只有很小的差异。然而,ACL组和对照组之间的差异表明,所涉及的腿部功能尚未完全恢复,ACL撕裂不仅是机械性破坏,而且会影响感觉运动的完整性。手术后可能无法恢复。ACL-IB后行走过程中膝盖动作和半腱肌功能异常减少的趋势值得进一步研究,并可能强调保留腿筋肌作为ACL激动剂的重要性。
方法:三级,病例对照研究。
背景:clinicaltrials.gov,NCT04429165(2020年12月6日)。
BACKGROUND: Little is known about knee mechanics and muscle control after augmented ACL repair. Our aim was to compare knee biomechanics and leg muscle activity during walking between the legs of patients 2 years after InternalBraceTM-augmented anterior cruciate ligament repair (ACL-IB) and between patients after ACL-IB and ACL reconstruction (ACL-R), and controls.
METHODS: Twenty-nine ACL-IB, 27 sex- and age-matched ACL-R (hamstring tendon autograft) and 29 matched controls completed an instrumented gait analysis. Knee joint angles, moments, power, and leg muscle activity were compared between the involved and uninvolved leg in ACL-IB (paired t-tests), and between the involved legs in ACL patients and the non-dominant leg in controls (analysis of variance and posthoc Bonferroni tests) using statistical parametric mapping (SPM, P < 0.05). Means and 95% confidence intervals (CI) of differences in discrete parameters (DP; i.e., maximum/minimum) were calculated.
RESULTS: Significant differences were observed in ACL-IB only in minimum knee flexion angle (DP: 2.4°, CI [-4.4;-0.5]; involved > uninvolved) and maximum knee flexion moment during stance (-0.07Nm/kg, CI [-0.13;-0.00]; involved < uninvolved), and differences between ACL-IB and ACL-R only in maximum knee flexion during swing (DP: 3.6°, CI [0.5;7.0]; ACL-IB > ACL-R). Compared to controls, ACL-IB (SPM: 0-3%GC, P = 0.015; 98-100%, P = 0.016; DP: -6.3 mm, CI [-11.7;-0.8]) and ACL-R (DP: -6.0 mm, CI [-11.4;-0.2]) had lower (maximum) anterior tibia position around heel strike. ACL-R also had lower maximum knee extension moment (DP: -0.13Nm/kg, CI [-0.23;-0.02]) and internal knee rotation moment (SPM: 34-41%GC, P < 0.001; DP: -0.03Nm/kg, CI [-0.06;-0.00]) during stance, and greater maximum semitendinosus activity before heel strike (DP: 11.2%maximum voluntary contraction, CI [0.1;21.3]) than controls.
CONCLUSIONS: Our results suggest comparable ambulatory knee function 2 years after ACL-IB and ACL-R, with ACL-IB showing only small differences between legs. However, the differences between both ACL groups and controls suggest that function in the involved leg is not fully recovered and that ACL tear is not only a mechanical disruption but also affects the sensorimotor integrity, which may not be restored after surgery. The trend toward fewer abnormalities in knee moments and semitendinosus muscle function during walking after ACL-IB warrants further investigation and may underscore the importance of preserving the hamstring muscles as ACL agonists.
METHODS: Level III, case-control study.
BACKGROUND: clinicaltrials.gov, NCT04429165 (12/06/2020).