Young Athletes After Anterior Cruciate Ligament Reconstruction With Single-Leg Landing Asymmetries at the Time of Return to Sport Demonstrate Decreased Knee Function 2 Years Later
Young Athletes After Anterior Cruciate Ligament Reconstruction With Single-Leg Landing Asymmetries at the Time of Return to Sport Demonstrate Decreased Knee Function 2 Years Later
复制标题
DOI：
10.1177/0363546517708996
复制
发表时间：
2017-09-01
影响因子：
4.8
通讯作者：
Schmitt, Laura C.
中科院分区：
文献类型：
--
作者：
Ithurburn, Matthew P.;Paterno, Mark V.;Schmitt, Laura C.
背景：以往的研究表明，青年运动员前交叉韧带重建术(ACLR)后，在恢复运动(RTS)时表现出单腿着地运动不对称性；然而，还没有研究ACLR后运动不对称性对膝关节相关功能的影响。第一个假设是，与那些表现对称的SL下降着陆机制的运动员相比，在RTS中表现出SL下降不对称的年轻运动员在2年后会出现膝关节功能下降。研究设计：队列研究；证据水平，2。方法：这项研究包括48名年轻运动员，他们曾接受过ACLR治疗，并在RTS时接受评估(女性77%，RTS时平均[+/-SD]年龄17.6+/-2.6岁)，并在RTS后随访2年。采用三维运动分析的方法，计算出三个感兴趣的矢状面着陆变量：膝关节屈曲偏移、膝关节最大伸展力矩和躯干最大屈曲。使用以下公式计算每个着陆变量的肢体对称性指数(LSI)：LSI=(受累/未受累)x 100%。LSI被用来根据每个着陆变量将队列分为对称组(SYM)和非对称组(ASYM)：膝关节屈曲偏移(SYM：LSI&Gt；=90%[n=23]；ASYM：LSI<；=90%[n=18])、膝关节最大内伸展力矩(SYM：LSI>；=90%[n=19]；ASYM：LSI<；85%[n=22])和最大躯干屈曲(SYM：LSI 115%[n=19])。在RTS术后2年，使用膝关节损伤和骨关节炎结果评分(KOS)、国际膝关节文件委员会(IKDC)的主观膝关节形态和SL HOP测试中的表现来评估膝关节相关功能。功能恢复的定义是基于文献中膝关节相关功能测量的分界值。由于非正态分布，使用Mann-Whitney U检验比较了对称组之间两年期函数的差异。结果：术后2年无膝关节屈曲偏转组的膝关节功能恢复明显低于SYM组(ASYM：93.0+/-8.2；SYM：98.4+/-3.0；P=.008)和Koos-Quality of Life(ASYM：81.6+/-16.1；SYM：94.1+/-9.7；P=.008)。在控制股四头肌力量LSI和移植物类型后，膝关节屈曲偏移与术后2年的Koos-Pain和Koos-Quality-Life的膝关节功能恢复有关(分别为P=0.033和P=0.012)。结论：ACLR术后2年时膝关节运动学不对称的年轻运动员报告的自我报告功能下降；然而，这些差异的临床重要性需要进一步了解。
Background: Previous work shows that young athletes after anterior cruciate ligament reconstruction (ACLR) demonstrate single-leg (SL) landing movement asymmetries at the time of return to sport (RTS); however, the effect of movement asymmetries on longitudinal knee-related function after ACLR has not been examined.Hypothesis/Purpose: The purpose of this study was to examine the effect of SL drop-landing movement symmetry at the time of RTS on knee-related function 2 years later in young athletes after ACLR. The first hypothesis was that young athletes who demonstrated SL drop-landing asymmetries at RTS would demonstrate decreased knee function 2 years later compared with those who demonstrated symmetric SL drop-landing mechanics. The second hypothesis was that SL drop-landing movement symmetry at RTS would be associated with knee functional recovery 2 years later.Study Design: Cohort study; Level of evidence, 2.Methods: This study included 48 young athletes who had undergone ACLR and were assessed at the time of RTS (77% female; mean [+/- SD] age at RTS, 17.6 +/- 2.6 years) and followed for 2 years after RTS. Three sagittal-plane landing variables of interest were calculated using 3-dimensional motion analysis during an SL drop-landing task at the time of RTS: knee flexion excursion, peak internal knee extension moment, and peak trunk flexion. The limb symmetry index (LSI) was calculated for each landing variable using the following: LSI = (involved/uninvolved) x 100%. The LSI was used to divide the cohort into symmetric (SYM) and asymmetric (ASYM) groups for each landing variable: knee flexion excursion (SYM: LSI >= 90% [n = 23]; ASYM: LSI < 85% [n = 18]), peak internal knee extension moment (SYM: LSI >= 90% [n = 19]; ASYM: LSI < 85% [n = 22]), and peak trunk flexion (SYM: LSI 115% [n = 19]). At 2 years after RTS, knee-related function was evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective knee form, and performance on SL hop tests. Functional recovery was defined based on literature cutoffs for knee-related functional measures. Differences in 2-year function were compared between the symmetry groups using Mann-Whitney U tests because of nonnormality. Logistic regression was used to determine if landing symmetry at the time of RTS would be associated with 2-year knee functional recovery after RTS.Results: The ASYM knee flexion excursion group demonstrated decreased function at 2 years after RTS compared with the SYM group on the KOOS-Pain (ASYM: 93.0 +/- 8.2; SYM: 98.4 +/- 3.0; P = .008) and the KOOS-Quality of Life (ASYM: 81.6 +/- 16.1; SYM: 94.1 +/- 9.7; P = .008). Knee flexion excursion was associated with knee functional recovery on the KOOS-Pain and the KOOS-Quality of Life (P = .033 and P = .012, respectively) at 2 years after RTS, after controlling for the quadriceps strength LSI and graft type.Conclusion: Young athletes after ACLR with asymmetries in knee kinematics at the time of RTS reported decreased self-reported function 2 years later; however, the clinical importance of these differences needs to be further understood.