| Objective: To study the mechanism of knee osteoarthritis treated with arthroscopic debridement and release of lateral patellar retinaculum; Study the musculus quadriceps fexoris and hamstring functional characteristics of knee osteoarthritis;To study the effect of arthroscopic debridement and release of lateral patellar retinaculum on the musculus quadriceps fexoris and hamstring functional; Based on the BP neural network to establish the model of curative effect estimation of arthroscopic debridement for knee osteoarthritis.Methods: 50 patients with knee osteoarthritis were randomly divided into groups A (29 cases) and B (21 cases) to underwent arthroscopic debridement and arthroscopic debridement combined with lateral patellar decompression respectively. All the operations were performed by a same surgeon. Postoperative rehabilitation therapies were carried out by one group of therapist. The Lysholm, PRI, PPI scores , isokinetic muscle strength test and surface electromyogram test were evaluated before the operation . The examinations were repeated in 3 and 6 months respectively after surgery.Based on the BP neural network to establish the model of curative effect estimation of arthroscopic debridement for knee osteoarthritis. Input end is preoperative case history , complaints, physical sign, auxiliary examination and the changes in the knee joint during operation of the knee OA patients. Output end is the postoperative curative effect. 50 cases of knee OA patient treated with arthroscopic debridement were divided into two groups, 35 cases were used to train the artificial neural network, 15 cases were to test the network. Results:1 Clinical results:In group A , the scores of Lysholm and PPI determined at postoperative 3 months were significantly higher than those before the operative, but not changed markedly at month 6. Whereas, in group B, the scores kept being increased after the surgery. At month 3, the scores in group A were higher than those in group B, however, at months 6, the Lysholm scores in group B were higher than those in group A. At month 3, the curatively effective rate of group A was higher than that of group B, however, at month 6, the rate of group B was higher than that of group A.2 Isokinetic muscle strength test resultsThe peak torque of the unaffected side were higher than affected side at angular speed of 120°/s and 180°/s, but there was no difference at angular speed of 180°/s. The hamstring's peak torque was no significant difference between the two sides. The quadriceps's relative peak torque of the unaffected side was higher than that of affected at angular speed of 60°/s,120°/s,180°/s, however the hamstring's relative peak torque was no significant difference between the two sides. The quadriceps's average power of the unaffected side was higher than that of the affected side at angular speed of 60°/s,120°/s.The hamstring's average power was no significant difference between the two sides. The quadriceps's total work of unaffected side was higher than that of the affected side at angular speed of 60°/s,120°/s,180°/s. The H/Q rate of the affected side was higher than that of the affected side.In group A the peak torque of postoperative month 3 was higher than that of preoperative at angular speed of 60°/s,120°/s, but there was no difference between month 3 and month 6. In group B there was no difference between preoperative and postoperative month 3, but month 6 was higher than that of month 3. At postoperative month 6, the peak torque of group B was higher than that of group A at all three angular speed. In group A the average power of postoperative month 3 was higher than that of preoperative at all three angular speed, but there was no difference between between month 3 and month 6. In group B there was no difference between preoperative and postoperative month 3, but month 6 was higher than that of month 3. In group A the total work of postoperative month 3 was higher than that of preoperative at all three angular speed, but there was no difference between between month 3 and month 6. In group B there was no difference between preoperative and postoperative month 3, but month 6 was higher than that of month at angular speed of 60°/s and 120°/s. There was no difference between group A and group B on the hamstring's peak torque,total work and average power, as well as the month 3 and month 6.There was no difference between group A and group B on H/Q rate preoperative, as well as month 3 and month 6.3 Surface electromyogram test resultsThe average sEMG of the unaffected side VL was higher than that of the affected side at range of 90-100°,100-110°and 120-130°. The average sEMG of the unaffected side RF was higher than that of affected side at range of 110~120°,120~130°, and the unaffected side VMO is higher than affected side at range of 110~120°,140~150°,150-160°.The unaffected side BF is higher than affected side at range of 150-160°.The VMO/VL rate of unaffected side was higher than that of affected side at angular speed of 60°/s and 180°/s. There was no significant difference at angular speed 120°/s. VMO of unaffected side was activated more early 6 second than that of affected side.The MVC average sEMG of group A and group B didn't changed significantly preoperative, month 3 and month 6. Normalized the sEMG of isokinetic eccentric exercise, the VL average sEMG of group A was higher than that of group B at angular speed of 60°/s, as RF at angular speed of 60°/s and 120°/s. There was no difference on VMO,ST and BF. The VMO/VL rate of group A changed no significantly on preoperative, postoperative month 3 and month 6. The preoperative VMO/VL rate of group B was higher than month 3 at angular speed of 60°/s,120°/s,180°/s.And there was no significant difference between month 3 and month 6. In group B VMO was activated more early than VL on month 3 and month 6.4 Based on the BP neural network to establish the model of curative effect estimation of arthroscopic debridement for knee osteoarthritis. 86 cases of knee OA patient treated with arthroscopic debridement were divided into two groups, 66 cases were used to train the artificial neural network, 20 cases were to test the network. There was no difference between the real value and predictive value. The network had a good predictive function. There was no excessive curve fitting during network training.Conclusion:①The patients of OA treated with arthroscopic debridement and release of lateral patellar retinaculum had a good curative effect, which provide a good condition to the rehabilitation.②The patients of OA treated with arthroscopic debridement and release of lateral patellar retinaculum experience a quadriceps compensation period and recovery period.③The extensional and flexional muscle peak torque,total work and average power of the patients of OA increased significantly after rehabilitation, specially quadriceps.The H/Q rate was in normal range preoperative, but decreased after operation.④The VMO/VL rate and VMO and VL activation time changed remarkably after operation in group B, which showed that release of lateral patellar retinaculum can improve the coordination of VMO and VL.⑤Rehabilitation after operation play an important role in increasing the muscle strength and the knee joint function.⑥BP network had a strong simulated and predictive ability, which can extract the relation between input and output from the distortion and defect information. This study establish the curative effective estimation model of knee OA patients treated with arthroscopic debridment, which provide a effective method to judge the prognosis of knee OA treated with arthroscopic debridment.
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