Strength Asymmetry and Landing Mechanics at Return to Sport after Anterior Cruciate Ligament Reconstruction.
Strength Asymmetry and Landing Mechanics at Return to Sport after Anterior Cruciate Ligament Reconstruction.
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DOI：
10.1249/mss.0000000000000560
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发表时间：
2015-07
影响因子：
4.1
通讯作者：
Hewett TE
中科院分区：
文献类型：
--
作者：
Schmitt LC;Paterno MV;Ford KR;Myer GD;Hewett TE
缺乏基于证据的前交叉韧带（ACL）重建后恢复运动的股四头肌（QF）力量指南。本研究调查了ACL重建后恢复运动时QF力量不对称对膝关节着地生物力学的影响。77名患者（17.4岁）在初次ACL重建后恢复运动时（ACLR组）和47名未受伤的对照组患者（17.0岁）（CTRL组）参加了研究。评估QF强度并计算股四头肌指数（QI = [受累强度/未受累强度]*100%）。ACLR组根据QI分为高股四头肌组（HQ，QI≥90%）和低股四头肌组（LQ，QI<85%）。膝关节运动学和动力学变量收集在下降垂直跳跃动作。采用多元方差分析和线性回归分析，比较各组着陆时肢体对称性和离散变量。与HQ和CTRL组相比，LQ组在所有动力学和地面反作用力变量中表现出更差的不对称性，包括受累肢体峰值膝关节外屈曲力矩减少（p<.001），受累肢体峰值垂直地面反作用力减少（p=.003）和未受累肢体峰值垂直地面反作用力增加（p=.005），以及未受累肢体峰值载荷率更高（p<.004）。HQ组和CTRL组的着陆模式在任何变量上都没有差异（p> 0.05）。在ACLR组中，在控制移植物类型、半月板损伤、膝关节疼痛和症状后，QF强度估计着陆期间的肢体对称性。在恢复运动的时候，具有较弱QF的ACL重建后的个体表现出改变的着陆模式。相反，那些具有几乎对称的QF强度的人表现出与未受伤的人相似的着陆模式。考虑客观QF力量测量可能有助于临床决策，以优化ACL重建后的运动参与。
Evidence-based quadriceps femoris muscle (QF) strength guidelines for return to sport following anterior cruciate ligament (ACL) reconstruction are lacking. This study investigated the impact of QF strength asymmetry on knee landing biomechanics at the time of return to sport following ACL reconstruction. Seventy-seven individuals (17.4 years) at the time of return to sport following primary ACL reconstruction (ACLR group) and 47 uninjured control individuals (17.0 years) (CTRL group) participated. QF strength was assessed and Quadriceps Index calculated (QI = [involved strength/uninvolved strength]*100%). The ACLR group was sub-divided based on QI: High Quadriceps (HQ, QI≥90%) and Low-Quadriceps (LQ, QI<85%). Knee kinematic and kinetic variables were collected during a drop vertical jump maneuver. Limb symmetry during landing, and discrete variables were compared among the groups with multivariate analysis of variance and linear regression analyses. The LQ group demonstrated worse asymmetry in all kinetic and ground reaction force variables compared to the HQ and CTRL groups, including reduced involved limb peak knee external flexion moments (p<.001), reduced involved limb (p=.003) and increased uninvolved limb (p=.005) peak vertical ground reaction forces, and higher uninvolved limb peak loading rates (p<.004). There were no differences in the landing patterns between the HQ and CTRL groups on any variable (p>.05). In the ACLR group, QF strength estimated limb symmetry during landing after controlling for graft type, meniscus injury, knee pain and symptoms. At the time of return to sport, individuals post-ACL reconstruction with weaker QF demonstrate altered landing patterns. Conversely, those with nearly symmetrical QF strength demonstrate landing patterns similar to uninjured individuals. Consideration of an objective QF strength measure may aid clinical decision-making to optimize sports participation following ACL reconstruction.