Influence of patellar ligament insertion angle on quadriceps usage during walking in anterior cruciate ligament reconstructed subjects

Reduced quadriceps contraction has been suggested as an adaptation to prevent anterior tibial translation in anterior cruciate ligament (ACL)-deficient knees. This theory has been supported by a recent study that peak knee flexion moment (thought to be created by a decrease of quadriceps contraction) during walking was negatively correlated with patellar ligament insertion angle (PLIA) in ACL-deficient knees, but not in contralateral, uninjured knees. In addition, the PLIA was significantly smaller in ACL-deficient knees than in contralateral, uninjured knees. However, it is unknown whether ACL reconstruction restores the PLIA or whether the relationship between the PLIA and knee flexion moments previously observed in ACL-deficient knees disappears. This study tested the following hypotheses: (1) The PLIA of ACL-reconstructed knees is significantly smaller than the PLIA of uninjured contralateral knees; (2) Peak knee flexion moment (balanced by net quadriceps moment) during walking is negatively correlated with the PLIA in ACL-reconstructed knees. The PLIA of 24 ACL-reconstructed and contralateral knees were measured using MRI, and peak knee flexion moments during walking were measured. Results showed that the PLIA of ACL-reconstructed (22.9 ± 4.4°) knees was not significantly smaller (p = 0.09, power = 0.99) than the PLIA of contralateral (24.1 ± 4.8°) knees. Peak knee flexion moment was not correlated with the PLIA following ACL reconstruction (R² = 0.016, power = 0.99). However, the magnitude of the knee flexion moment remained significantly lower in ACL-reconstructed knees. In summary, this study has shown that the PLIA of ACL-reconstructed knees returned to normal and that patients no longer adapt their gait in response to the PLIA, though quadriceps function did not return to normal levels. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 730–735, 2009     

超声引导收肌管阻滞联合关节周围浸润对小儿膝关节术后的镇痛效果

目的 探讨超声引导收肌管阻滞（CACB）联合关节周围浸润镇痛（PLIA）对小儿膝关节术后的镇痛效果。方法 选取2016年2月～2018年3月我院骨科收治的78例单侧膝关节手术患儿为研究对象,根据不同麻醉方案分为观察组（n=38）和对照组（n=40）,观察组采用超声引导收肌管阻滞联合关节周围浸润镇痛,对照组采用单纯超声引导收肌管阻滞镇痛。采用视觉疼痛模拟评分（VAS）评价两组术后的疼痛程度,并观察记录术后镇痛的满意度及股四头肌肌力减弱情况,比较两组术后膝关节活动度及术后并发症等情况。结果 观察组镇痛满意度在术后6h、12h、24h明显高于对照组,差异有统计学意义（P＜0.05）;观察组股四头肌肌力减弱发生率在术后4h、6h、12h显著低于对照组,差异亦有统计学意义（P＜0.05）。观察组VAS评分在术后24h明显低于对照组（P＜0.05）,但在术后4h、6h、12h,两组VAS评分无明显差异（P＞0.05）。观察组直腿抬高时间、被动屈膝90°角时间均显著低于对照组（P＜0.05）;两组并发症总发生率比较,观察组（5.3%）显著低于对照组（22.5%）,差异亦有统计学意义（P＜0.05）。 结论 超声引导收肌管阻滞联合关节周围浸润镇痛用于小儿膝关节术后镇痛临床效果明显,有利于膝关节活动度,缩短预后时间,促进预后,可在临床上推广使用。