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O’Donoghue Award Winner

机译：O’Donoghue奖获得者

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Background: Altered knee kinematics after anterior cruciate ligament injury and reconstruction (ACLR) have been implicated in the development of premature osteoarthritis (OA), leading to poor long term clinical outcomes. Purpose: This study was performed to determine (1) whether average knee center of rotation (KCOR), a multidimensional metric of knee kinematics, of the ACLR knee during walking differs from that of the contralateral uninjured knee, (2) whether KCOR changes between 2 and 4 years after surgery, and (3) whether early KCOR changes predict patient reported outcomes 8 years after ACLR. Study Design: Prospective Clinical Study. Methods: Twenty-six human subjects underwent gait analysis with calculation of bilateral KCOR during walking at 2 and 4 years after unilateral ACLR. Knee injury and Osteoarthritis Outcome Scores (KOOS) and Lysholm scores were collected at 2, 4, and 8 years after ACLR in 13 of these subjects. Results: The ACLR knee showed greater medial compartment motion due to pivoting about a more lateral KCOR (P=0.03) than the uninjured contralateral knee at 2 years. KCOR moved medially over time (P=0.047), with values approaching those of the uninjured knee by 4 years (P=0.55). KCOR was also more anterior in the ACLR knee at 2 years (P=0.02). Between 2 and 4 years, KCOR moved posteriorly in 16 (62%) and anteriorly in 10 (38%) subjects. Increasing anterior position of KCOR in the ACLR knee from 2 to 4 years showed no correlation with clinical outcomes at 4 years but correlated with worsening clinical outcomes at 8 years: Lysholm (R2=0.41); KOOS pain (R2=0.37), symptoms (R2=0.58), and quality of life (R2=0.50). Conclusions: The observed changes to KCOR during walking between 2 and 4 years after ACLR show progressive improvement suggestive of continued graft maturation and neuromuscular recovery. The finding of increasingly abnormal kinematics correlating with reduced clinical outcomes years later in a subset of subjects provides a potential explanation for the incidence of premature OA following ACLR. These findings support progressing to more comprehensive studies of larger cohorts examining the predictive potential of KCOR for OA risk as measured by advanced quantitative imaging and radiographs. Clinical Relevance: These results suggest that changes to KCOR during walking as derived from gait analysis, a clinically available metric, may provide early warning of deteriorating knee function after ACLR years before the onset of clinical symptoms.
机译：背景：前交叉韧带损伤和重建（ACLR）后膝关节运动学改变与早产骨关节炎（OA）的发展有关，导致长期的临床结果较差。目的：本研究旨在确定（1）行走过程中ACLR膝盖的平均膝关节旋转中心度（KCOR），即膝关节运动学的多维度量标准，与对侧未受伤膝关节的平均膝关节旋转中心（KCOR）之间是否发生变化？手术后2年和4年，以及（3）是否早期KCOR改变可预测ACLR后8年患者报告的结局。研究设计：前瞻性临床研究。方法：对26名受试者进行了步态分析，计算了单侧ACLR后2年和4年步行时的双侧KCOR。在其中13位受试者的ACLR后第2、4和8年收集膝关节损伤和骨关节炎结果评分（KOOS）和Lysholm评分。结果：在2年时，ACLR膝部比未受伤的对侧膝部绕着更外侧的KCOR旋转（P = 0.03），从而显示出更大的内侧房室运动。 KCOR在一段时间内向内移动（P = 0.047），其值接近未受伤膝盖的值4年（P = 0.55）。 2年时，ACCOR膝关节的KCOR也更靠前（P = 0.02）。在2至4年之间，KCOR在16位受试者（62％）中向后移动，在10位受试者（38％）中向前移动。 ACLR膝关节KCOR的前位从2年增加到4年，与4年的临床结果无关，但与8年的临床结果恶化相关：Lysholm（R2 = 0.41）; KOOS疼痛（R2 = 0.37），症状（R2 = 0.58）和生活质量（R2 = 0.50）。结论：ACLR后2至4年的步行过程中观察到的KCOR变化显示出逐渐改善，提示持续的移植物成熟和神经肌肉恢复。几年后，在一组受试者中发现越来越多的异常运动学与临床结果降低相关，这为ACLR导致过早OA的发生提供了可能的解释。这些发现支持对大型人群进行更全面的研究，以检查KCOR通过先进的定量成像和X线照片测量的OA风险的预测潜力。临床相关性：这些结果表明，步态分析（一种临床可用的度量标准）得出的步行过程中KCOR的变化可能会在ACLR出现临床症状之前，对膝关节功能恶化提供预警。

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