Gait adaptations before and after anterior cruciate ligament reconstruction surgery
Gait adaptations before and after anterior cruciate ligament reconstruction surgery
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DOI：
10.1097/00005768-199707000-00003
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发表时间：
1997-07-01
期刊：
影响因子：
--
通讯作者：
Mahar, MT
中科院分区：
文献类型：
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作者：
DeVita, P;Hortobagyi, T;Mahar, MT
前交叉韧带（ACL）缺陷和重建的康复个体的步态分析已经确定了增加髋伸肌扭矩和腿筋肌电图（EMG）和减少膝伸肌扭矩和股四头肌肌电图在站立期间的最终适应。然而，对损伤和手术的最初适应是未知的，影响适应发展的因素也是未知的。确定对伤害的最初反应将为确定最终适应是自动习得的还是经过长期训练的结果提供基础，在长期训练中，各种因素可能会影响其发展。本研究的目的是评估ACL损伤和重建手术对行走过程中关节运动学、动力学和能量学的初步影响。9例ACL损伤受试者的伤肢在损伤后2周、手术后3周和5周进行测试。测试了10名健康受试者。收集运动学和地面反应数据，并结合逆动力学计算关节扭矩和功率。在所有测试中，在受伤的肢体中观察到大部分站立时的膝伸肌扭矩。这一结果与之前在ACL重建康复患者和ACL缺陷患者中观察到的伸肌扭矩或屈肌扭矩降低相矛盾。这一结果也不同于健康对照受试者典型的站立中期伸肌然后屈肌扭矩。趋势分析显示，术后3周髋、膝关节平均位置、髋关节伸肌角冲动和髋关节正功发生显著变化（P < 0.001），术后5周部分康复。康复治疗5周后，膝关节产生的功率和功减少了5倍（P < 0.001），并且没有恢复到手术前的水平。损伤后2周存在持久的膝伸肌扭矩表明ACL缺陷的适应过程是漫长的，需要许多步态周期，并且许多因素可能涉及学习适应。
Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitaton at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.