ACL损伤合并软骨病变患者步态中膝关节部位特异性生物力学改变
简介
本研究纳入116例单侧前交叉韧带（ACL）缺失患者，分为单纯ACL缺失组（ACLDI）、合并股骨软骨损伤组（ACLDF）、合并胫骨软骨损伤组（ACLDT）及合并股骨-胫骨联合损伤组（ACLDC），通过三维运动捕捉分析步行时膝关节六自由度运动学。关键发现：经半月板状态校正后，各组在膝关节外展-内收、屈伸及前后位移维度上存在显著差异。与ACLDI组相比，ACLD…
英文摘要
BACKGROUND: Anterior cruciate ligament (ACL) deficiency often coexists with articular cartilage damage, yet the biomechanical effects of lesion location on knee kinematics during gait remain unclear. This study investigated the association between cartilage lesion site and six degrees of freedom (6-DOF) knee kinematics in ACL-deficient knees. METHODS: A total of 116 patients with unilateral ACL deficiency were divided into four groups: isolated ACL deficiency (ACLDI), ACL with femoral cartilage lesion (ACLDF), ACL with tibial cartilage lesion (ACLDT), and ACL with combined femoral-tibial lesions (ACLDC). Three-dimensional motion capture was used to record knee 6-DOF kinematics during walking. One-way ANOVA and Statistical Parametric Mapping (SPM1d) were applied to identify intergroup differences. Key discrete gait parameters were further reanalyzed using meniscal-adjusted linear models. RESULTS: Meniscal-adjusted analyses indicated that group differences remained in selected gait parameters. Specifically, differences were identified in the abduction-adduction, flexion-extension, and anterior-posterior displacement dimensions. Compared with the ACLDI group, ACLDT and ACLDC patients exhibited greater adduction and anterior tibial translation during the stance phase, while ACLDF and ACLDC showed reduced knee flexion and overall range of motion. CONCLUSION: In ACL-deficient knees, gait biomechanical alterations are associated with cartilage lesion location. Different lesion locations appear to correspond to distinct functional phenotypes, suggesting that lesion-specific assessment may improve identification of residual instability and inform more individualized rehabilitation strategies to restore joint stability and reduce the risk of secondary degeneration.