| Objective:To measure and analyze the difference in the posterior tibial slope between patients with simple anterior cruciate ligament injury and those with meniscus injury,so as to study the correlation between meniscus injury and the posterior tibial slope in patients with ACL injury,and to explore the predictive value of different posterior tibial slope on the risk of combined meniscus injury.The gait characteristics of the patients were also analyzed to assess the kinematic changes in patients with ACL combined with meniscal injuries,with the aim of providing reference and guidance for the future diagnosis and selection of rehabilitation strategies for related diseases.Part I.Correlation study of combined meniscus injury and posterior tibial slope inpatients with anterior cruciate ligament injuryMethods:Sixty-seven patients with confirmed ACL combined with meniscal injury who visited our hospital from October 2020 to December 2021 were collected as study subjects and included as the experimental group.Another 40 patients with simple ACL injury were selected as the control group.All patients were collected from lateral knee X-rays and other relevant imaging data,and the posterior tibial slope was measured and calculated.The difference in the posterior tibial slope between the two groups was analyzed using the independent samples t-test,and the difference in the incidence of combined meniscal injury between patients with PTS≥12~°and those with PTS<12~°was also compared using the?~2-test to investigate the correlation between PTS and meniscus injury in patients with ACL injury.Results:The mean of posterior tibial slope was 11.96~°±2.59~°in the ACL combined meniscal injury group and 10.88~°±2.79~°in the simple ACL injury group,a decrease of 1.08~°compared with the combined meniscal injury group,with a statistical difference between the two groups(P<0.05).Among the 67 cases with combined meniscal injury in ACL,there were 41 patients(61.19%)with posterior tibial slope≥12~°and 26 patients(38.81%)with posterior tibial slope<12~°;Among the 40 control cases,there were 16 patients(40%)with posterior tibial slope≥12~°and 24(60%)with posterior tibial slope<12~°.The difference between the two groups was statistically significant(?~2=4.520,P<0.05).Part II Three-dimensional joint kinematic analysis of anterior cruciate ligamentcombined with meniscal injuryMethods:A total of 42 patients with simple anterior cruciate ligament and combined meniscus injury who were treated in our hospital from October 2020 to December 2021 were selected.Among them,16 patients with simple ACL injury were listed as the control group;26 patients with anterior cruciate ligament combined with meniscus injury were listed as the experimental group.The gait parameters such as stride speed,stride length,gait cycle,single/total support phase,static load-bearing force and other gait parameters of the two groups were compared and analyzed by t-test.The mixed design two-way ANOVA method was used to analyze the contact area,maximum pressure,support phase,and the range of motion of each joint between the groups and the affected side.The follow-up test method was analyzed by independent samples t-test;If it is shown that there is an interaction effect between the two factors of the group and the both sides,the independent sample t-test is used to study the group and the both sides,respectively,and the influence of the combined meniscus injury and the both sides on the kinematics of the lower extremity gait is compared and analyzed.Results:(1)There was no significant difference in stride speed,stride length,stride duration and gait cycle between subjects with simple ACL injury and those with combined meniscus injury(P>0.05).At the same time,the results of the study showed that there was no statistical difference in static weight-bearing resultant force between the two groups of subjects(P=0.815),but there was a significant statistical difference between the affected side and the healthy side(P<0.001).(2)The effects of the two groups of subjects without meniscus injury on the touchdown area,maximum pressure,maximum impulse,single support phase and total support phase in the whole gait analysis process showed no statistical significance(P>0.05).At the same time,the study showed that in addition to the maximum pressure(P=0.079),the touchdown area,maximum impulse,single support phase,and total support phase during walking were statistically significant between the affected and healthy sides(P<0.05).(3)There was a statistically significant difference in the maximum flexion angle of the knee joint between the two groups with or without meniscus injury(P=0.032),and there was no statistical difference in the range of motion of the hip,knee and ankle joints during the rest of the gait process(P>0.05).Conclusion:(1)The posterior tibial slope is an important risk factor for meniscus injury in patients with anterior cruciate ligament injury,and larger posterior tibial slope is associated with combined meniscus injury.For patients with higher PTS,more attention should be paid to the diagnosis and treatment of meniscus injury in order to restore the biomechanical stability of the knee joint by early repair.(2)The degree of abnormal gait in patients with anterior cruciate ligament combined with meniscus injury is higher than that in patients with simple ACL injury.At the same time,compared with the unaffected side,the loss of gait and motor function on the affected side is also more significant.(3)Gait analysis can dynamically and quantitatively evaluate the motor function of the lower limbs of patients.Therefore,in the future,the treatment methods and rehabilitation strategies can be formulated based on gait kinematics for patients with ACL combined meniscus injury,and more benefit. |
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