摘要

背景：

前交叉韌帶重建后，步態(tài)期間的生物力學(xué)不對(duì)稱非常普遍、持續(xù)，并與創(chuàng)傷后膝關(guān)節(jié)骨關(guān)節(jié)炎有關(guān)。股四頭肌力量是與術(shù)前步態(tài)不對(duì)稱和術(shù)后功能相關(guān)的重要臨床指標(biāo)，也是恢復(fù)運(yùn)動(dòng)清除的主要標(biāo)準(zhǔn)。股四頭肌力量對(duì)稱性與步態(tài)生物力學(xué)相關(guān)的證據(jù)僅限于恢復(fù)運(yùn)動(dòng)訓(xùn)練前的術(shù)前和早期康復(fù)時(shí)間點(diǎn)。

目的/假設(shè)：

確定運(yùn)動(dòng)員前交叉韌帶重建后恢復(fù)運(yùn)動(dòng)訓(xùn)練后等長(zhǎng)股四頭肌力量對(duì)稱性與步態(tài)生物力學(xué)之間的關(guān)系。我們假設(shè)，隨著股四頭肌力量對(duì)稱性的增加，運(yùn)動(dòng)員將表現(xiàn)出更對(duì)稱的膝關(guān)節(jié)生物力學(xué)，包括步態(tài)期間的脛股關(guān)節(jié)負(fù)荷。

研究設(shè)計(jì)：

橫斷面研究。

方法：

參加ACL-SPORTS的79名運(yùn)動(dòng)員中有10名在完成術(shù)后康復(fù)和7次恢復(fù)運(yùn)動(dòng)訓(xùn)練（ACLR后1.2±0.100個(gè)月）后成為本研究的參與者。所有參與者都使用機(jī)電測(cè)功機(jī)完成了生物力學(xué)步行步態(tài)分析和等長(zhǎng)股四頭肌強(qiáng)度評(píng)估。股四頭肌力量使用肢體對(duì)稱指數(shù)（受累肢體值/未受累肢體值 x 0%）計(jì)算。感興趣的生物力學(xué)變量包括：峰值膝關(guān)節(jié)屈曲角（PKFA），峰值膝關(guān)節(jié)內(nèi)伸力矩，體重接受和站位中期的矢狀面膝關(guān)節(jié)偏移，PKFA處的股四頭肌肌力和峰值內(nèi)側(cè)間室接觸力。利用Spearman's rho（ρ）相關(guān)系數(shù)分別確定股四頭肌力量肢體對(duì)稱指數(shù)與各生物力學(xué)變量的關(guān)系;alpha 設(shè)置為 05.<>。

結(jié)果：

在76名參與者中，27名（35%）表現(xiàn)出股四頭肌力量不對(duì)稱，定義為股四頭肌力量對(duì)稱性<90%（n = 23）或>110%（n = 4）（QI范圍：56.9%-131.7%）。對(duì)于感興趣的生物力學(xué)變量，67%的膝關(guān)節(jié)峰值屈曲角度不對(duì)稱，重量接受和中期的膝關(guān)節(jié)偏移分別為68%和83%，膝關(guān)節(jié)內(nèi)伸展力矩為74%，內(nèi)側(cè)間室接觸力為57%，股四頭肌肌力為74%。恢復(fù)運(yùn)動(dòng)訓(xùn)練后，股四頭肌力量指數(shù)與肢體對(duì)稱指數(shù)之間沒有顯著相關(guān)性（p>0.129）。

結(jié)論：

在ACL重建后完成恢復(fù)運(yùn)動(dòng)訓(xùn)練的患者中，隨后的股四頭肌力量對(duì)稱性與步態(tài)生物力學(xué)的持續(xù)不對(duì)稱性無(wú)關(guān)。在達(dá)到股四頭肌力量閾值后，僅恢復(fù)力量可能無(wú)法改善步態(tài)不對(duì)稱，目前的臨床干預(yù)和恢復(fù)運(yùn)動(dòng)訓(xùn)練可能無(wú)法充分針對(duì)步態(tài)。

Abstract

Background:?After anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training.

Purpose/hypothesis:?The purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait.

Study design:?Cross-sectional study; Level of evidence, 3.

Methods:?Of 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05.

Results:?Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training (P?> .129).

Conclusion:?Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.?

From：

Am J Sports Med.?2021 Feb;49(2):417-425.

?doi: 10.1177/0363546520980079