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目的 探讨股四头肌肌力对前十字韧带重建术后髌股关节软骨损伤的影响.方法 2009年12月至2013年8月前十字韧带断裂重建术后1年以上行内固定取出术的患者76例,男51例,女25例;前十字韧带重建术时患者年龄16～44岁,平均27.6岁.取内固定术前行双侧股四头肌、腘绳肌等速肌力测试,取内固定的同时行二次关节镜检查,观察髌骨和滑车软骨损伤情况,分析股四头肌、腘绳肌肌力与髌股关节软骨损伤分级的关系.结果 前十字韧带重建术至二次关节镜检查的时间为12～51个月,平均25.3个月.前十字韧带重建术后34例患者(45％)患侧与健侧股四头肌肌力比值≤80％,17例患者(22％)患侧与健侧腘绳肌肌力比值≤80％.将患者分为患侧与健侧股四头肌肌力比值＞80％组(42例)与肌力比值≤80％组(34例).两组分别有9例(21％)和16例(47％)出现术后髌骨软骨损伤分级增加,髌骨软骨损伤加重发生率的差异有统计学意义;两组髌骨软骨损伤分级平均增加0.10和0.68级,差异有统计学意义.两组分别有11例(26％)和11例(32％)出现术后滑车软骨损伤分级增加,滑车软骨损伤加重发生率的差异无统计学意义;两组滑车软骨损伤分级平均增加0.55和0.71级,差异无统计学意义.结论 前十字韧带重建术后股四头肌肌力恢复到健侧的80％以上,可明显减少髌骨软骨损伤的发生和加重.“,”Objective To evaluate the effect of quadriceps strength on the patellofemoral joint cartilage status after anterior cruciate ligament (ACL) reconstruction.Methods Seventy-six patients undergoing ACL reconstruction in our institute received second-look arthroscopy for the metal staple removal at least one year postoperatively from December 2009 to August 2013.The patients consisted of 51 males and 25 females with an average age of 27.6 years (range:16 to 44) at the time of ACL reconstruction.Patients underwent standardized isokinetic testing for both quadriceps and hamstrings before second-look arthroscopy.Arthroscopic evaluation of patella and trochlea cartilage status for all patients was performed at the index ACL reconstruction and the second-look arthroscopy.The effect of quadriceps and hamstrings strength on patellofemoral joint cartilage status was investigated.Results The average follow-up time from ACL reconstruction to second-look arthroscopy was 25.3 months (range:12 to 51).After ACL reconstruction,45％ of patients had a 20％ or greater quadriceps deficit and 22％ had hamstring weakness of 20％ or more.Patients were divided into 2 groups:less than 20％ quadriceps deficit group with 42 patients and 20％ or greater deficit group with 34 patients.For patella cartilage,chondral worsening was found in 9 patients (21％) and 16 patients (47％) in two groups respectively,with a statistically significant difference in favor of the former group.The mean worsening grades of patella cartilage were 0.10 and 0.68 respectively,whereby the former group was significantly less than that in the latter group.For trochlea cartilage,chondral worsening was detected in 11 patients (26％) and 11 patients (32％) in these two groups respectively,with no significant difference.The mean worsening grades of trochlea cartilage were 0.55 and 0.71 in the two groups respectively,with no significant difference.Conclusion A recovery of ＞80％ in quadriceps strength after ACL reconstruction could lead to less severe cartilage damage at the patella.