Influence of patellar position on the knee extensor mechanism in normal and crouched walking

JOURNAL OF BIOMECHANICS

卷:51

Article

Lenhart, Rachel L.¹  Brandon, Scott C. E.²  Smith, Cohn R.²  Novacheck, Tom F.^3,4  Schwartz, Michael H.^3,4  Thelen, Darryl G.^1,2,5 

[1] Univ Wisconsin, Dept Biomed Engn, Madison, WI 53706 USA

[2] Univ Wisconsin, Dept Mech Engn, Madison, WI 53706 USA

[3] Gillette Childrens Specialty Healthcare, St Paul, MN USA

[4] Univ Minnesota Twin Cities, Dept Orthopaed Surg, Minneapolis, MN USA

[5] Univ Wisconsin, Dept Orthoped & Rehabil, Madison, WI 53706 USA

关键词: Cerebral palsy;    Patella position;    Patella alta;    Patella baja;    Knee extensor;    Moment arm;   

DOI  :  10.1016/j.jbiomech.2016.11.052

来源: Elsevier

【 摘 要 】

Patella alta is common in cerebral palsy, especially in patients with crouch gait. Correction of patella alta has been advocated in the treatment of crouch, however the appropriate degree of correction and the implications for knee extensor function remain unclear. Therefore, the goal of this study was to assess the impact of patellar position on quadriceps and patellar tendon forces during normal and crouch gait. To this end, a lower extremity musculoskeletal model with a novel 12 degree of freedom knee joint was used to simulate normal gait in a healthy child, as well as mild (23 deg min knee flexion in stance), moderate (41 deg), and severe (67 deg) crouch gait in three children with cerebral palsy. The simulations revealed that quadriceps and patellar tendon forces increase dramatically with crouch, and are modulated by patellar position. For example with a normal patellar tendon position, peak patellar tendon forces were 0.7 times body weight in normal walking, but reached 2.2,3.2and5.4times body weight in mild, moderate and severe crouch. Moderate patella alta acted to reduce quadriceps and patellar tendon loads in crouch gait, due to an enhancement of the patellar tendon moment arms with alta in a flexed knee. In contrast, patella baja reduced the patellar tendon moment arm in a flexed knee and thus induced an increase in the patellar tendon loads needed to walk in crouch. Functionally, these results suggest that patella baja could also compromise knee extensor function for other flexed knee activities such as chair rise and stair climbing. The findings are important to consider when using surgical approaches for correcting patella alta in children who exhibit crouch gait patterns. (C) 2016 Elsevier Ltd. All rights reserved.

【 授权许可】

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