Background

Both graft type and surgical technique for anterior cruciate ligament reconstruction can affect knee biomechanics. Several studies reported the influence of graft type, but few have controlled the surgical technique and fully investigated stair ambulation. This study aimed to compare knee biomechanics during stair ambulation between patients treated with hamstring tendon graft and those treated with patellar tendon graft when anterior medial portal technique was used to drill femoral tunnel.

Methods

Two groups of patients (patellar tendon, n = 18; hamstring tendon, n = 18) at average 12 months after reconstruction surgery were recruited to ascend and descend a customized staircase in a gait lab. Joint kinematics and kinetics were calculated for both operated and contralateral intact limbs based on kinematic analysis and inverse dynamics. The influence of graft type on knee flexion angle and moment was identified using one-way mixed (graft type and limb side) analysis of variance with post-hoc paired t-test.

Findings

Significant interaction between graft and limb was found for knee flexion and range of motion. Only the hamstring tendon group had significant kinematic deficits on the operated limb than the contralateral limb during stair ascent and descent. No significant interaction was found for knee flexion moment. Both graft groups had significant deficits in peak knee flexion moment on the operated side during stair ascent and descent.

Interpretation

While the choice of graft type does not affect the restoration of knee dynamic loading, patellar tendon graft better restores knee flexion-extension kinematics during stair ambulation.

中文翻译：

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移植物类型对前十字韧带重建术后下肢行走时矢状面膝关节生物力学的影响

背景

移植物类型和前交叉韧带重建的手术技术都会影响膝关节生物力学。几项研究报道了移植物类型的影响，但很少有人控制外科手术技术并充分研究了阶梯运动。这项研究的目的是比较在使用前内侧门技术钻入股骨隧道时，绳肌腱移植患者和pa骨肌腱移植患者在楼梯移动过程中的膝关节生物力学。

方法

 在步态实验室中，平均召集重建手术后平均12个月的两组患者（pat肌腱，n = 18；绳肌腱，n = 18）。基于运动学分析和逆动力学，计算了手术和对侧完整肢体的关节运动学和动力学。使用事后配对t检验，通过单向混合（移植物类型和肢体侧面）方差分析确定了移植物类型对膝盖屈曲角度和力矩的影响。

发现

发现移植物和四肢之间的重要相互作用可导致膝盖弯曲和运动范围。在楼梯上升和下降过程中，只有绳肌腱组的活动肢体运动能力较对侧肢体明显。膝关节屈曲力矩未发现明显的相互作用。在楼梯上升和下降过程中，两个移植物组的手术侧膝关节屈伸力矩峰值均明显不足。

解释

虽然选择移植物类型不会影响膝关节动态负荷的恢复，但pa骨肌腱移植物可以更好地恢复楼梯移动时的膝关节屈伸运动学。