Ambulatory knee biomechanics and muscle activity 2 years after ACL surgery: InternalBrace TM -augmented ACL repair versus ACL reconstruction versus healthy controls.

Autor: Bühl L; Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland. linda.buehl@usb.ch.; Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland. linda.buehl@usb.ch.; Department of Clinical Research, University of Basel, Basel, 4031, Switzerland. linda.buehl@usb.ch., Müller S; Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.; Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.; Department of Clinical Research, University of Basel, Basel, 4031, Switzerland., Nüesch C; Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.; Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.; Department of Clinical Research, University of Basel, Basel, 4031, Switzerland.; Department of Spine Surgery, University Hospital Basel, Basel, 4031, Switzerland., Boyer KA; Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA.; Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, 01655, USA., Casto E; Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA., Mündermann A; Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.; Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.; Department of Clinical Research, University of Basel, Basel, 4031, Switzerland.; Department of Spine Surgery, University Hospital Basel, Basel, 4031, Switzerland., Egloff C; Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.; Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.; Department of Clinical Research, University of Basel, Basel, 4031, Switzerland.
Jazyk: angličtina
Zdroj: BMC musculoskeletal disorders [BMC Musculoskelet Disord] 2023 Oct 04; Vol. 24 (1), pp. 785. Date of Electronic Publication: 2023 Oct 04.
DOI: 10.1186/s12891-023-06916-7
Abstrakt: Background: Little is known about knee mechanics and muscle control after augmented ACL repair. Our aim was to compare knee biomechanics and leg muscle activity during walking between the legs of patients 2 years after InternalBrace TM -augmented anterior cruciate ligament repair (ACL-IB) and between patients after ACL-IB and ACL reconstruction (ACL-R), and controls.
Methods: Twenty-nine ACL-IB, 27 sex- and age-matched ACL-R (hamstring tendon autograft) and 29 matched controls completed an instrumented gait analysis. Knee joint angles, moments, power, and leg muscle activity were compared between the involved and uninvolved leg in ACL-IB (paired t-tests), and between the involved legs in ACL patients and the non-dominant leg in controls (analysis of variance and posthoc Bonferroni tests) using statistical parametric mapping (SPM, P < 0.05). Means and 95% confidence intervals (CI) of differences in discrete parameters (DP; i.e., maximum/minimum) were calculated.
Results: Significant differences were observed in ACL-IB only in minimum knee flexion angle (DP: 2.4°, CI [-4.4;-0.5]; involved > uninvolved) and maximum knee flexion moment during stance (-0.07Nm/kg, CI [-0.13;-0.00]; involved < uninvolved), and differences between ACL-IB and ACL-R only in maximum knee flexion during swing (DP: 3.6°, CI [0.5;7.0]; ACL-IB > ACL-R). Compared to controls, ACL-IB (SPM: 0-3%GC, P = 0.015; 98-100%, P = 0.016; DP: -6.3 mm, CI [-11.7;-0.8]) and ACL-R (DP: -6.0 mm, CI [-11.4;-0.2]) had lower (maximum) anterior tibia position around heel strike. ACL-R also had lower maximum knee extension moment (DP: -0.13Nm/kg, CI [-0.23;-0.02]) and internal knee rotation moment (SPM: 34-41%GC, P < 0.001; DP: -0.03Nm/kg, CI [-0.06;-0.00]) during stance, and greater maximum semitendinosus activity before heel strike (DP: 11.2%maximum voluntary contraction, CI [0.1;21.3]) than controls.
Conclusion: Our results suggest comparable ambulatory knee function 2 years after ACL-IB and ACL-R, with ACL-IB showing only small differences between legs. However, the differences between both ACL groups and controls suggest that function in the involved leg is not fully recovered and that ACL tear is not only a mechanical disruption but also affects the sensorimotor integrity, which may not be restored after surgery. The trend toward fewer abnormalities in knee moments and semitendinosus muscle function during walking after ACL-IB warrants further investigation and may underscore the importance of preserving the hamstring muscles as ACL agonists.
Level of Evidence: Level III, case-control study.
Trial Registration: clinicaltrials.gov, NCT04429165 (12/06/2020).
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje