30 2 291 295 2015 原著 9 1 Correlation of Knee Extension Moment during Walking with Anterior Tibial Translation at 1 Year after Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autografts 1,2) 3) 1) 1) 1) 1) 1) 1) 4) 4) YUTARO IKENO, RPT 1,2), SATOSHI TANAKA, RPT, PhD 3), EIJI YAMADA, RPT, PhD 1), WATARU FUKUDA, RPT, MS 1), YUSUKE KATAOKA, RPT 1), YUKA HAMANO, RPT 1), KENTA TAKEUCHI, RPT 1), SHOUHEI KAWAKAMI, RPT 1), TAISHI NINOMIYA, MD 4), NORIYUKI GOMI, MD, PhD 4) 1) Department of Physical Therapy in Affilation with a Center of Orthopaedic Surgery, The Taijyukai Foundation (social medical corporation) Kaisei General Hospital: 3-5-28 Muro, Sakaide-shi, Kagawa 762-0007, Japan. TEL+81 877-46-1011 E-mail: yutaro_ikeno1986@yahoo.co.jp 2) Prefectural University of Hiroshima, Graduate School of Comprehensive Scientific Research 3) Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima 4) Center of Orthopaedic Surgery, The Taijyukai Foundation (Social Medical Corporation) Kaisei General Hospital Rigakuryoho Kagaku 30(2): 291 295, 2015. Submitted Oct. 17, 2014. Accepted Dec. 16, 2014. ABSTRACT: [Purpose] The relationship between the knee extension moment in the early walking stage at 9 weeks after anterior cruciate ligament (ACL) reconstruction surgery with hamstring tendon autografts (STG) on anterior tibial translation (ATT) at one year post-surgery were investigated to clarify the influence of knee extension moment on ligament reconstruction. [Subjects] Ten cases of ACL reconstruction using STG (20 limbs: 10 operated, 10 nonoperated). [Methods] The knee extension moment of the early walking stage at 9 weeks post-surgery was computed from 3D motion analysis data and ground reaction force, and normalized to body weight. At one year post-surgery ATT was determined. [Results] The knee extension moment at 9 weeks post surgery of the operated side showed a significantly lower value than that of the non-operated side, but it was not related to ATT at one year post-surgery. [Conclusion] To prevent secondary injury, improvement of the decreased knee extension moment in the early walking stage at 9 weeks after ACL reconstruction surgery is necessary. Key words: anterior cruciate ligament, knee extension moment, anterior tibial translation 要旨 : STG ACL 9 1 ATT STG ACL 10 20 9 1 ATT 9 9 1 ACL 9 キーワード : 1) : 3-5-28 762-0007 TEL 0877-46-1011 2) 3) 4) 2014 10 17 2014 12 16
292 30 2 I. はじめに Anterior Cruciate Ligament; ACL Anterior Tibial Translation; ATT ACL ACL 1,2) 3) ACL anterior shear force Houck 4) ACL ACL Berchuck 5) Quadriceps Avoidance Gait; QAG ACL Knoll 6) Bone patellar tendon Bone; BTB ACL QAG ACL 6 4 8 Webster 7) ACL BTB Semitendinosus and Gracilis tendon; STG STG BTB ATT 8) STG ACL 9 1 II. 対象と方法 1 STG ACL 10 20 ACL 1 ACL ACL 2 ADL ACL 2011-4 2 ACL 0 9 4 SONY DCR-HC7 60 Hz 1 AMTI-JAPAN AccuGait 60 Hz ToMoCo-VM FP 表 1 10 7 3 24.4 6.7 cm 168.5 9.5 kg 64.7 13.8 BMI kg/m 2 22.6 2.7 2 1 ACL 3.7 3.6 ACL mm 7.5 4.3 BMI; Body Mass Index
9 1 293 表 2 ACL 1 1/3 2 1/2 3 2/3 1 2 3 4 5 6 ToMoCo-VM 10 N 10N 5 ToMoCo-VM Intraclass correlation coefficient; ICC intra-class reliability; 1 1 0.78 60 Hz 4 inter-class reliability; 2 1 0.80 LED ICC 0.9 1 1 2.5 2 1 2.3 10) 3 9) 11) 1 2 10 1 5.7 m 1/3 5 11) 10 30 mm ToMoCo-VM FP 3 ACL 1 4 KneeLax KNL 1 ATT 3 ACL 9 100 3 Wilcoxon 0 50 1 ATT Pearson
294 30 2 表 3 95 Nm/kg 1.79 2.28 0.02 0.05* 0.097 3.260 Nm/kg *: p<0.01 mean SD IBM SPSS Statistics GRAD PACK version 22.0 5 III. 結果 15 mm 3 Shapiro-Wilk ACL 9 1.79 2.28 Nm/kg 0.02 0.05 Nm/kg 3 1 ATT 0.90 1.69 mm 1 ATT r=0.50 p=0.14 IV. 考察 ACL 8 ACL 12) ACL 13) Solomonow 14) ACL mechanoreceptor 15) ACL 1 ACL ACL 2 ATT ACL ACL 1 ATT 3,16) 17) 18) Barber 19) ACL 18) 3) ACL 9 1 ATT ACL 9 18) 4 LED 1/60 STG ACL 9 1 ACL 9 1 ATT ACL 9
9 1 295 引用文献 1) Finsterbush A, Frankle U, Matan Y, et al.: Secondary damage to the knee after isolated injury of the anterior cruciate ligament. Am J Sports Med, 1990, 18(5): 475 479. 2) : ACL. 2005 30(1): 78 81 3) 1995 16: 229 232 4) Houck J, Yack HJ: Associations of knee angles, moments and function among subjects that are healthy and anterior cruciate ligament deficient (ACLD) during straight ahead and crossover cutting activities. Gait Posture, 2003, 18(1): 126 138. 5) Berchuck M, Andriacchi TP, Bach BR, et al.: Gait adaptations by patients who have a deficient anterior cruciate ligament. J Bone Joint Surg, 1990, 72(6): 871 877. 6) Knoll Z, Kiss RM, Kocsis L: Gait adaptation in ACL deficient patients before and after anterior cruciate ligament reconstruction surgery. J Electromyogr Kinesiol, 2004, 14(3): 287 294. 7) Webster KE, Wittwer JE, O Brien J, et al.: Gait patterns after anterior cruciate ligament reconstruction are related to graft type. Am J Sports Med, 2005, 33(2): 247 254. 8) Devita P, Hortobagyi T, Barrier J, et al.: Gait adaptations before and after anterior cruciate ligament reconstruction. Med Sci Sport Exerc, 1997, 29(7): 853 858. 9) 4 3. 2014 29(4): 233 237. 10). B 1988 12: 141 149. 11). 13 1996 pp125 138. 12) ACL MRI. 2006 14(3): 279 283. 13) 2003 12(3): 234 240. 14) Solomonow M, Baratta R, Zhou BH, et al.: The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability. Am J Sports, 1987, 15(3): 207 213. 15) 1 2013 28(5): 681 684. 16) Zabala ME, Favre J, Scanlan SF, et al: Three-dimensional knee moments of ACL reconstructed and control subjects during gait, stair ascent, and stair descent. J Biomech, 2013, 46(3): 515 520. 17). 2003 19(4): 513 518. 18) 2010 pp161 166. 19) Barber-Westin SD, Noyes FR, Heckmann TP, et al.: The effect of exercise and rehabilitation on anterior-posterior knee displacements after anterior cruciate ligament autograft reconstruction. Am J Sports Med, 1999, 27(1): 84 93.