Background:After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living.Purpose:To assess long-term alterations in lower limb mechanics in patients after PCLR.Study Design:Descriptive laboratory study.Methods:A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping.Results:Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee ( P = .005). During the sit-to-stand task, higher flexion angles during the midcycle ( P = .017) and lower external rotation angles ( P = .049) were found in the reconstructed knee; sagittal knee ( P = .001) and hip ( P = .016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle ( P = .006 and P = .040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task ( P = .010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb ( P < .001).Conclusion:Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand.Clinical Relevance:After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments.

中文翻译：

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孤立性和复合性后十字韧带损伤重建后 8 年髋部和踝部的活动依赖性代偿


背景：后交叉韧带重建（PCLR）后，膝关节功能缺陷可能持续存在。目前尚不清楚在日常生活的高要求活动期间邻近关节是否代偿膝关节。目的：评估 PCLR 后患者下肢力学的长期变化。研究设计：描述性实验室研究。方法：总共 28 名接受 PCLR 治疗的患者术后 8.2 ± 2.2 年接受单束单侧孤立或联合 PCLR 执行楼梯导航、下蹲、从坐到站和从站到坐的任务。运动捕捉和测力台用于收集运动学和动力学数据。然后，使用统计参数映射将重建肢体的 3 维髋关节、膝关节和踝关节运动学数据与对侧肢体的运动学数据进行比较。结果：在向上驱动运动期间，主要发现膝关节的左右差异。手术后8年。与对侧膝关节相比，重建膝关节在上楼梯的初始加载阶段表现出较低的内旋 (P = .005)。在从坐站到站的任务中，重建的膝关节在周期中期具有较高的屈曲角度 (P = .017) 和较低的外旋角度 (P = .049)；重建肢体的矢状膝关节 ( P = .001) 和髋关节 ( P = .016) 力矩低于对侧肢体。在向下驱动的运动中，膝盖处的左右差异很小，但踝关节和臀部的差异很明显：在楼梯下降过程中，与对侧踝关节相比，重建的踝关节在周期中期表现出较低的背屈和较低的外旋（P = . 006 和 P = .040，分别）。 在从站到坐的任务中，重建肢体的正面髋力矩高于对侧肢体 ( P = .010)；深蹲期间，重建肢体的矢状髋角高于对侧肢体 ( P < .001)。结论：PCLR 后的患者在向下驱动的运动（例如下楼梯、深蹲、和站着坐。相反，在上楼梯和坐站等向上驱动运动期间，检测到膝盖处残留的长期左右差异。临床相关性：PCLR 后，生物力学功能的左右差异是活动依赖并发生在膝关节或邻近关节处。当参考对侧肢体来评估重建肢体的膝关节功能时，应优先考虑向心、向上驱动的运动。向下驱动运动过程中髋部和踝部的代偿会导致长期功能评估出现偏差。