Impaired Quadriceps Rate of Torque Development and Knee Mechanics After Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft
Impaired Quadriceps Rate of Torque Development and Knee Mechanics After Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft
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DOI：
10.1177/0363546515595834
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发表时间：
2015-10-01
影响因子：
4.8
通讯作者：
Noehren, Brian
中科院分区：
文献类型：
--
作者：
Kline, Paul W.;Morgan, Kristin D.;Noehren, Brian
背景：扭矩发展速率（RTD）测量肌肉快速产生扭矩的能力。股四头肌RTD降低可能会损害术后运动任务的表现。目前，对前交叉韧带（ACL）重建和非损伤肢体之间股四头肌RTD的变化知之甚少。目的：确定自体髌腱移植重建ACL后，股四头肌RTD、膝伸肌力矩（KEM）发展的速率和时间以及跑步过程中膝关节屈曲偏移的差异。研究设计：横断面研究;证据等级：3。方法：本研究涉及21名患者（11名女性），均在自体髌腱移植物ACL重建后6个月（中位数[IQR]：年龄：18 [16-20]岁;体重：68.18 [61.34-75] kg;身高：1.74 [1.66-1.78] m）。患者在等速测力计上进行了4次5秒最大自主等长力量试验。RTD计算为达到峰值扭矩总时间的20%至80%之间的扭矩-时间曲线的平均斜率。然后，患者进行了三维运动分析，同时运行在一个仪器跑步机上，在一个自我选择的运行速度（平均SD，2.68 ± 0.28米/秒）。膝关节伸肌力矩（RKEM）的速率计算为在站立相的10%和30%之间的力矩曲线的平均斜率。结果：与健侧相比，重建侧股四头肌最大扭矩发展速率在等长轴向和等长轴向上均存在明显的差异（P < 0. 05），而在等长轴向上，重建侧股四头肌最大扭矩发展速率在等长轴向上均存在明显的差异（P < 0. 05）。（RTD，257.56 vs 569.11 Nm/s; P < .001）和动态（RKEM，16.47 vs 22.38 Nm/kgms; P < .001）。与未损伤肢体相比，重建肢体在站立期也产生了较晚的KEM（11.37% vs 9.61%; P <0.001），并且发生了较少的膝关节屈曲偏移（15.5 ° vs 19.8 °; P <0.001）。RTD和KEM时间的偏差可能会改变膝关节的负荷方式，并可能增加损伤风险和未来创伤后骨关节炎的发展。康复应考虑旨在改善RTD的练习，并为运动表现的要求做好肢体准备。
Background: Rate of torque development (RTD) measures the ability of a muscle to produce torque quickly. Decreased quadriceps RTD may impair performance of sporting tasks after surgery. Currently, little is known about variations in quadriceps RTD between anterior cruciate ligament (ACL)-reconstructed and noninjured limbs.Purpose: To determine the differences in RTD of the quadriceps, the rate and timing of knee extensor moment (KEM) development, and knee flexion excursion during running after ACL reconstruction with patellar tendon autograft.Study Design: Cross-sectional study; Level of evidence, 3.Methods: This study involved 21 patients (11 female) 6 months after ACL reconstruction with patellar tendon autograft (median [IQR]: age, 18 [16-20] years; mass, 68.18 [61.34-75] kg; height, 1.74 [1.66-1.78] m). Patients performed four 5-second maximal voluntary isometric strength trials of both limbs on an isokinetic dynamometer. RTD was calculated as the mean slope of the torque-time curve between 20% and 80% of total time to peak torque. Then, patients underwent 3-dimensional motion analysis while running on an instrumented treadmill at a self-selected running speed (mean SD, 2.68 0.28 m/s). The rate of knee extensor moment (RKEM) was calculated as the mean slope of the moment curve between 10% and 30% of stance phase. Between-limb comparisons were determined with a paired t test for peak KEM, RKEM, knee flexion excursion during 10% to 30% of stance, and time to generate KEM.Results: In the reconstructed limb, deficits in the peak rate of quadriceps torque development compared with the noninjured limb existed both isometrically (RTD, 257.56 vs 569.11 Nm/s; P < .001) and dynamically (RKEM, 16.47 vs 22.38 Nm/kgms; P < .001). The reconstructed limb also generated a KEM later in the stance phase compared with the noninjured limb (11.37% vs 9.61% stance; P < .001) and underwent less knee flexion excursion (15.5 degrees vs 19.8 degrees; P < .001).Conclusion: After ACL reconstruction with patellar tendon autograft, patients have lower RTD and RKEM in the reconstructed limb. Deviations in RTD and the timing of the KEM can change the way the knee is loaded and can potentially increase injury risk and future development of posttraumatic osteoarthritis. Rehabilitation should consider exercises designed to improve RTD and prepare the limb for the demands of sport performance.