The effect of manipulation under anesthesia on knee kinematics in individuals with arthrofibrosis after anterior cruciate ligament reconstruction.

IF 2.8 3区医学 Q1 ORTHOPEDICS

Journal of Orthopaedic Surgery and Research Pub Date : 2024-11-06 DOI:10.1186/s13018-024-05159-z

Ling Zhang, Shuai Fan, Xuan Zhao, Ye Luo, Bin Cai, Shao-Bai Wang

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引用次数: 0

Abstract

Background: Manipulation under anesthesia (MUA) has been recommended for refractory arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. However, the effectiveness of MUA to restore normal kinematics of the arthrofibrotic knee is still unclear. The objective of this study was to evaluate tibiofemoral and patellofemoral kinematics in six degrees-of-freedom (6DOF) in patients with arthrofibrosis before and after MUA.

Methods: Computed tomography and dual fluoroscopic imaging system were used to assess in vivo knee kinematics. Ten patients (6 women and 4 men; 32.6 ± 6.5y, 168.4 ± 7.8 cm, 61.8 ± 13.2 kg) were included in this study. The tibiofemoral and patellofemoral kinematics in 6DOF were collected before and one year after MUA. A simple analysis of variance was used to evaluate kinematic data of preoperative arthrofibrotic knee, postoperative arthrofibrotic knee, and the contralateral knee.

Results: The patella in the postoperative arthrofibrotic knee shifted significantly more inferiorly compared to the preoperative knee at 45° (P = 0.010), 60° (P = 0.008), and 75° (P = 0.049) of flexion. The patellar flexion in the postoperative arthrofibrotic knee significantly increased at 45° (P = 0.048), 60° (P = 0.037), and 75° (P = 0.006) of flexion compared to the preoperative arthrofibrotic knee. The patellar tilt was significantly decreased at 60° (P = 0.006) and at 75° (P = 0.037) of knee flexion in the postoperative arthrofibrotic knee compared to the contralateral knee. MUA significantly increased tibial internal rotation angle in the arthrofibrotic knee at 45° (P = 0.047), at 60° (P = 0.033), and at 75° (P = 0.021) of knee flexion.

Conclusions: MUA could restore normal patellar inferior shift, flexion, and tibial rotation compared to the contralateral side. However, the MUA could not restore normal patellar tilt of the arthrofibrotic knee. This indicated that improvement of patellar tilt should be emphasized in postoperative rehabilitation.

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前十字韧带重建术后关节纤维化患者在麻醉状态下进行操作对膝关节运动学的影响。

背景：对于前交叉韧带（ACL）重建后的难治性关节纤维化，人们推荐使用麻醉下手法治疗（MUA）。然而，MUA 对恢复关节纤维化膝关节正常运动学的有效性仍不明确。本研究的目的是评估关节纤维化患者在MUA前后的胫股关节和髌股关节在六个自由度（6DOF）上的运动学特性：采用计算机断层扫描和双透视成像系统评估膝关节的活体运动学。本研究共纳入 10 名患者（6 名女性和 4 名男性；32.6 ± 6.5 岁，168.4 ± 7.8 厘米，61.8 ± 13.2 千克）。在 MUA 之前和一年之后，收集了胫骨股骨和髌骨股骨在 6DOF 条件下的运动学数据。对术前膝关节纤维化、术后膝关节纤维化和对侧膝关节的运动学数据进行了简单的方差分析：结果：与术前相比，术后关节纤维化膝关节在屈曲 45°（P = 0.010）、60°（P = 0.008）和 75°（P = 0.049）时的髌骨下移幅度明显更大。与术前相比，术后关节纤维化膝关节在屈曲 45°（P = 0.048）、60°（P = 0.037）和 75°（P = 0.006）时的髌骨屈曲度明显增加。与对侧膝关节相比，术后关节纤维化膝关节在屈膝 60° (P = 0.006) 和 75° (P = 0.037) 时的髌骨倾斜度明显降低。MUA可明显增加关节纤维化膝关节在屈膝45°（P = 0.047）、60°（P = 0.033）和75°（P = 0.021）时的胫骨内旋角：结论：与对侧相比，MUA 可使髌骨下移、屈曲和胫骨旋转恢复正常。结论：与对侧相比，MUA 可以恢复正常的髌骨下移、屈曲和胫骨旋转，但 MUA 无法恢复关节纤维化膝关节的正常髌骨倾斜。这表明，在术后康复中应重视改善髌骨倾斜。

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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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.