Tibiofemoral Joint Contact Force Profiles of Pediatric Patients After Anterior Cruciate Ligament Reconstruction.

Elizabeth Bjornsen,J Troy Blackburn,Jason R Franz,W Zachary Horton,Darin A Padua,Sandra J Shultz,Samantha Tayne,Brian G Pietrosimone
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Abstract

BACKGROUND Incidence rates of pediatric anterior cruciate ligament (ACL) injuries and ACL reconstruction (ACLR) are increasing. In adult patients with ACLR, limb-level loading profiles are less dynamic compared with uninjured controls (ie, lesser peaks and minimal offloading during midstance) early post-ACLR, and less dynamic profiles are associated with deleterious knee tissue changes. However, joint-level loading magnitudes during gait in the pediatric ACLR population are unknown. PURPOSE/HYPOTHESIS The purpose of this study was to compare medial and lateral tibiofemoral joint contact force profiles between pediatric patients with ACLR and pediatric matched controls. It was hypothesized that pediatric patients with ACLR would demonstrate less dynamic medial and lateral joint contact force profiles compared with matched uninjured pediatric controls. STUDY DESIGN Cross-sectional study; Level of evidence, 2. METHODS Pediatric patients 6 to 24 months post-ACLR (n = 25) and matched pediatric controls (n = 25; Tanner stage category, sex, Tegner activity score ±3) underwent a gait biomechanical assessment at a single time point, where ground-reaction forces and marker trajectories were collected. The concurrent optimization of muscle activation and kinematics algorithm was utilized to estimate medial and lateral compartment tibiofemoral joint contact forces in the ACLR limb and pediatric matched control limb. A functional linear model was utilized to determine differences in joint contact force profiles throughout stance phase (0%-100%). RESULTS Pediatric patients with ACLR demonstrated a high occurrence of concomitant injuries (80% meniscal pathology; 13% chondral injuries) and walked with greater medial tibiofemoral joint contact forces in midstance (42%-63% of the stance phase; 339-N maximal difference) and greater lateral joint contact forces in the late stance compared with pediatric controls (69%-80%; 288 N). CONCLUSION Pediatric patients with ACLR may demonstrate a less dynamic tibiofemoral joint contact force loading profile in the medial compartment, as evidenced by greater loading during midstance, compared with matched pediatric controls.
小儿前交叉韧带重建后胫股关节接触力分析。
背景:儿童前交叉韧带(ACL)损伤和ACL重建(ACLR)的发生率正在上升。在成年ACLR患者中,与未受伤的对照组相比,ACLR后早期的肢体水平负荷曲线不太动态(即,在中间站立时,较低的峰值和最小的卸载),并且较低的动态曲线与有害的膝关节组织改变有关。然而,儿童ACLR人群步态中的关节水平负荷大小尚不清楚。目的/假设本研究的目的是比较小儿ACLR患者和儿童匹配对照组的内侧和外侧胫股关节接触力特征。假设与未受伤的儿童对照组相比,患有ACLR的儿童患者表现出较少的动态内侧和外侧关节接触力。研究设计横断面研究;证据等级2。方法aclr术后6 ~ 24个月的儿科患者(n = 25)和匹配的儿科对照组(n = 25; Tanner分期类别,性别,Tegner活动评分±3)在单一时间点进行步态生物力学评估,收集地面反作用力和标记物轨迹。利用肌肉激活和运动学并行优化算法估算ACLR肢体和儿童匹配对照肢体的内侧和外侧室胫股关节接触力。利用函数线性模型确定整个站立阶段(0%-100%)关节接触力分布的差异。结果ACLR的儿科患者伴随损伤发生率高(80%为半月板病理,13%为软骨损伤),行走时站立时胫股内侧关节接触力较大(站立期42%-63%,最大差值339-N),站立后期外侧关节接触力较大(站立期69%-80%,288 N)。结论:与儿童对照组相比,ACLR儿童患者可能表现出内侧室胫骨股骨关节接触力负荷较少的动态特征,这一点在站立时的负荷更大。
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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