The Analysis And Evaluation Of The Changes In Plantar Pressure After Anterior Cruciate Ligament Reconstruction Using Anterior-half The Peroneus Longus Tendon

Anterior cruciate ligament(ACL)plays important roles in restricting excessive tibia anterior translation and internal rotation, bearing the stress of joint, and limiting the valgus or varus and hyperextension of the knee. Injury of the ligament can cause joint instability, increasing the risk of injury of meniscus or cartilage and in turn early degeneration of joint. So in order to stabilize the knee joint, recovery of the function, prevent secondary injury of the cartilage and meniscus, reduce the progress of osteoarthritis in early stage, the choice of the ACL reconstruction surgery is very preferable.A number of factors such as the choice of the graft can affect the postoperative outcomes. Different graft materials were used in clinic, but every single one own its faultiness in term of either short-term or long-term outcomes. In case of multiple ligament injury, ligament revision or the condition that graft is not preferable to havest around the knee, limited graft materials can be selected to meet the requirements of operation.Recently, in the process of exploring new sources of ligament grafts, some scholars focus on long peroneal tendon(PLT).They thought PLT can meet the requires of the substitute of graft in ACLR whatever length diameter and biomechanical characteristics. Besides, PLT has superficial anatomical location and clear location make it easy to take with fewer complications. All of these advantages above make the tendon’s feasibility as the transplantation of suitable material much bigger.But as a very important anatomy structure in ankle joint, how much impact to corresponding regulatory regions in lack of PLT is not known? How serious these effects will lead to is still questionable. All these questions were mandatory to be answered. It is a urgent attention a surgeon need. Therefore many scholars began to make a series of different experiments constantly to make sure the effect after PLT removing. Although the results are generally optimistic, most of the evaluation way depend on subjectivity too much and most kinds of data were collected in static setup, lacking of objective comparison about muscle strength, range of motion and the stress change under the dynamic state after removing the PLT.The emergence and popularity of the gait analysis represented by dynamic plantar pressure test provided us a kind of experimental observation methods additionally. It can collect biomechanical parameters in a dynamic time, help researchers to calculate the data, timely and make the analysis and comparison the functions of plantar and ankle joint in the continuous movement.The studies were based on to compare and analyze the effect in tendon area after removing the AHPLT, and provide the objective advice about the feasibility of using PLT as ligament graft.Part one: Study on the Change of Temporal Plantar Pressure in Patients with Anterior Cruciate Ligament-Deficient KneeObjectiveTo measure temporal plantar pressure in patients with anterior cruciate ligament-deficient(ACLD), and analyze ACLD impact on the plantar pressureMethodsThe study was conducted on 31 subjects with isolated unilateral ACLD and a healthy CONTROL group(N=26). The test parameters including(1)the total planter contact duration and the percentages of four phases: Initial Contact Phase(ICP), Forefoot ContactPhase(FCP), Foot Flat Phase(FFP) and Forefoot Push-off Phase(FFPOP) relative to the single limb stance phase;(2) the average max force(MF) distribution of total plantar and subareas;(3) the time distribution used to reach MF(TMF);(4) the impulse(IP)distribution of total plantar and subareas;(5) the average max pressure(MP) distribution of total plantar and subareas were calculated. In addition, the differences in the parameters above among the affected side, non-affected side and control group were comparedResultsShorter ICP, FFCP, FFP and total planter contact duration were found in ACLD side as compared with non-affected side whereas greater FFPOP was observed. Shorter ICP and FFP were found in ACLD side as compared with control group whereas greater FFCP, FFPOP and total planter contact duration were observed. Compared with non-affected side and control group, ACLD side has significantly less MF, IP and MP in heel medial and heel lateral companied with greater TMF.ConclusionsFor fear of re-injury of ACLD limb which has lost normal functions, the patients likely avoid using the affected side and provide more protections for the homolateral heel during walking. Consequently, some parameters of temporal plantar pressure will be changed such as the total planter contact duration and the percentages of each phase. Besides, the greater magnitude of MF, MP, IP and the less time of TMF will also be demonstrated.Part two: Comparative Analysis of the Change of Temporal Plantar Pressure Between the Patients with Anterior Cruciate Ligament Reconstruction Using Anterior Half Long Peroneal Tendon and Hamstring TendonObjectiveTo comparative analyse the differences between the surgical curative effects using AHPLT and ST as ligament graft, and evaluate the effect in tendon area after removing the AHPLT, and provide the objective advice about the feasibility of using PLT as ligament graft.MethodsThe study was conducted on 27 subjects after ACLR using AHPLT and 61 subjects after ACLR using ST isolated. The test parameters are measured 6 months postoperativly including(1)the average max force(MF) distribution of total plantar and subareas;(2) the time distribution used to reach MF(TMF);(3) the impulse(IP) distribution of total plantar and subareas;(4) the average max pressure(MP) distribution of total plantar and subareas were calculated. In addition, the differences in the parameters above among the operative side of AHPLT group, ST group and control group were compared.ResultsCompared with normal group, the differents on MF, TMF, IP and MP were no statistical significance in AHPLT group(P > 0.05). Compared with ST group, MF, TMP and MP of midfoot area were higher and the differences above were statistically significant in AHPLT group(P < 0.05).ConclusionsThe influences on plantar area and ankle joints have no obvious difference generally between ACLR using AHPLT as graft and ACLR using ST as graft.There has little effect in tendon area after removing the AHPLT, and no obvious impact on plantar area and ankle joints.Using the PLT can expand clinical ligament reconstruction graft source effectively.