Gait Mechanics in Women of the ACL-SPORTS Randomized Control Trial: Interlimb Symmetry Improves Over Time Regardless of Treatment Group
Gait Mechanics in Women of the ACL-SPORTS Randomized Control Trial: Interlimb Symmetry Improves Over Time Regardless of Treatment Group
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DOI：
10.1002/jor.24314
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发表时间：
2019-08-01
影响因子：
2.8
通讯作者：
Snyder-Mackler, Lynn
中科院分区：
文献类型：
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作者：
Capin, Jacob J.;Zarzycki, Ryan;Snyder-Mackler, Lynn
前交叉韧带（ACL）损伤和ACL重建（ACLR）后的女性比男性更容易表现出不对称的运动模式，这与创伤后骨关节炎有关。我们开发了ACL专业术后恢复运动（ACL-SPORTS）随机对照试验，以测试力量、敏捷性、运动测量和二级预防（SAPP）训练（有和无扰动训练）（SAPP + PERT）对ACLR后女性步态力学的影响。我们假设两组的运动对称性都会随着时间的推移而改善，但在SAPP + PERT组中更是如此。在初级ACLR后3-9个月的3- 9名女运动员被随机分配到SAPP或SAPP + PERT训练组。在训练前（训练前）和训练后（训练后）以及术后1年和2年进行地上行走期间的生物力学测试。使用重复测量方差分析比较髋关节和膝关节运动学和动力学变量，Bonferroni校正用于事后比较（α = 0.05）。峰值膝关节屈曲角（PKFA）存在肢体相互作用时间效应（p = 0.028），这是为研究提供动力的主要结局，其特征是在训练前、训练后和1年（而非2年）时，治疗组中受累肢体的PKFA小于未受累肢体。在站立中期，矢状面膝关节偏移和动力学以及髋关节伸展偏移发生了类似的结果。没有涉及组的有意义的相互作用。无论是SAPP还是SAPP + PERT训练都不能改善步行力学，ACLR后持续1年而不是2年。临床意义声明：不对称运动模式在参与者达到对称力量和功能表现后持续很长时间，表明ACLR后需要更多时间才能完全恢复。(c)2019骨科研究学会。出版社：Wiley Periodicals，Inc. J Orthop Res 37：1743-1753，2019
Women after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) are more likely than men to exhibit asymmetric movement patterns, which are associated with post-traumatic osteoarthritis. We developed the ACL specialized post-operative return-to-sports (ACL-SPORTS) randomized control trial to test the effect of strength, agility, plyometric, and secondary prevention (SAPP) training with and without perturbation training (SAPP + PERT) on gait mechanics in women after ACLR. We hypothesized that movement symmetry would improve over time across both groups but more so among the SAPP + PERT group. Thirty-nine female athletes 3-9 months after primary ACLR were randomized to SAPP or SAPP + PERT training. Biomechanical testing during overground walking occurred before (Pre-training) and after (Post-training) training and one and 2 years post-operatively. Hip and knee kinematic and kinetic variables were compared using repeated measures analysis of variance with Bonferroni corrections for post hoc comparisons (alpha = 0.05). There was a time by limb interaction effect (p = 0.028) for peak knee flexion angle (PKFA), the primary outcome which powered the study, characterized by smaller PKFA in the involved compared to uninvolved limbs across treatment groups at Pre-training, Post-training, and 1 year, but not 2 years. Similar findings occurred across sagittal plane knee excursions and kinetics and hip extension excursion at midstance. There were no meaningful interactions involving group. Neither SAPP nor SAPP + PERT training improved walking mechanics, which persisted 1 but not 2 years after ACLR. Statement of clinical significance: Asymmetrical movement patterns persisted long after participants achieved symmetrical strength and functional performance, suggesting more time is needed to recover fully after ACLR. (c) 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1743-1753, 2019