长期随访中前交叉韧带重建术后患者被动松弛伴功能稳定揭示潜在的双侧动态代偿机制
简介
本研究对10-15年前接受ACL重建（ACLR）的患者与无伤对照者，通过CT评估被动胫股对位，并利用双平面视频X线摄影术分析单腿跳远落地时的动态三维膝关节运动学。关键发现：ACLR患膝的被动胫骨前移位置较对照者平均前移7.5 mm，较对侧健膝前移3.1 mm；然而，在动态跳跃落地时，患膝与对侧膝的峰值前移量无显著差异。进一步分析显示，ACLR患者的双膝在动态…
英文摘要
BACKGROUND: Knee stability can be conferred passively by ligaments and menisci and actively by the neuromuscular system. We sought to determine the relationship between passive tibiofemoral alignment and dynamic constraint in patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) and matched control participants who have been followed for more than a decade. PURPOSE/HYPOTHESIS: It was hypothesized that (1) anterior tibial position would be greater in the surgical knee compared to the contralateral knee and when compared to knees of control participants, and (2) the surgical limb differences would be greater in the dynamic state during a 1-leg hop-for-distance landing task. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 21 participants were recruited from a recently completed longitudinal clinical trial (NCT00434837): 10 patients who had undergone ACLR 10 to 15 years earlier and 11 matched control participants without knee injury. The 3-dimensional (3D) tibiofemoral position was extracted from each participant's computed tomography images as a measure of passive alignment. Dynamic 3D knee kinematics were recorded using biplane videoradiography during the landing of a 1-leg hop-for-distance activity. Side-to-side differences in knee kinematics between limbs were used as a measure of dynamic constraint. Peak anterior tibial position was the primary outcome measure, and peak anterior tibial position as a function of flexion angle was the secondary outcome measure. RESULTS: The passive tibial position of patients with ACLR was 7.5 ± 2.3 mm more anterior compared to that of uninjured participants and 3.1 ± 1.1 mm more anterior than their contralateral limb (P < .05). The mean peak dynamic anterior position was not different between surgical and contralateral limbs in ACLR patients (P = .83). When anterior position was explored as a function of flexion angle, peak anterior tibial position was up to 10.3 mm greater in the ACLR surgical limbs (P = .01) and 7.5 mm in the contralateral limbs (P = .001) compared to the limbs of control participants. CONCLUSION: Passive alignment is abnormal long after ACLR, whereas side-to-side dynamic constraint is largely restored, but with a persistent bias toward greater anterior tibial position that is present bilaterally. CLINICAL RELEVANCE: Compared with similar studies at earlier postoperative time points, the results at long-term follow-up suggest that ACL graft function deteriorates with time, which can be compensated for to some degree by the neuromuscular system.