Activity-Dependent Compensation at the Hip and Ankle at 8 Years After the Reconstruction of Isolated and Combined Posterior Cruciate Ligament Injuries

Alison N. Agres, Nicholas M. Brisson, Georg N. Duda, Tobias M. Jung
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Abstract

Background:After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living.Purpose:To assess long-term alterations in lower limb mechanics in patients after PCLR.Study Design:Descriptive laboratory study.Methods:A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping.Results:Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee ( P = .005). During the sit-to-stand task, higher flexion angles during the midcycle ( P = .017) and lower external rotation angles ( P = .049) were found in the reconstructed knee; sagittal knee ( P = .001) and hip ( P = .016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle ( P = .006 and P = .040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task ( P = .010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb ( P < .001).Conclusion:Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand.Clinical Relevance:After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments.
孤立性和合并性后交叉韧带损伤重建后 8 年髋关节和踝关节的活动依赖性代偿
背景:后交叉韧带重建术(PCLR)后,膝关节的功能障碍可能会持续存在。目的:评估 PCLR 术后患者下肢力学的长期改变。方法:共 28 名接受单束单侧孤立或联合 PCLR 的患者在术后 8.2 ± 2.2 年进行了楼梯导航、下蹲、坐立和站立任务。运动捕捉和力板用于收集运动学和动力学数据。结果显示:术后8年,膝关节的侧向差异主要体现在向上运动时。与对侧膝关节相比,重建膝关节在爬楼梯的初始加载阶段表现出较低的内旋(P = .005)。在从坐到站的运动中,重建膝关节的屈曲角度(P = 0.017)和外旋角度(P = 0.049)均高于对侧肢体;重建肢体的膝关节矢状矩(P = 0.001)和髋关节矢状矩(P = 0.016)均低于对侧肢体。在向下驱动的运动中,膝关节的侧向差异最小,但踝关节和髋关节的侧向差异突出:在下楼梯时,与对侧踝关节相比,重建踝关节在中周期表现出较低的背屈和较低的外旋(分别为 P = .006 和 P = .040)。结论:PCLR 患者在下楼梯、深蹲和站立时,髋关节和踝关节在向下运动时表现出代偿。临床意义:PCLR 后,生物力学功能的侧向差异与活动有关,发生在膝关节或邻近关节。在参照对侧肢体评估重建肢体的膝关节功能时,应优先考虑同心向上的运动。在向下驱动的运动中,髋关节和踝关节的代偿会导致长期功能评估出现偏差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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