Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training.
Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training.
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股四头肌力量对称性不会改变前交叉韧带重建、康复和回归运动训练后的步态力学。
DOI：
10.1177/0363546520980079
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Snyder-Mackler L
中科院分区：
文献类型：
--
作者：
Arhos EK;Capin JJ;Buchanan TS;Snyder-Mackler L
前十字韧带重建后，步态过程中的生物力学不对称非常普遍、持久，并与创伤后膝关节骨关节炎有关。股四头肌力量是一项与术前步态不对称和术后功能相关的重要临床指标，也是恢复运动能力的主要标准。将股四头肌力量的对称性与步态生物力学联系起来的证据仅限于手术前和重返运动训练前的早期康复时间点。目的：探讨运动员前交叉韧带重建术后恢复运动训练后股四头肌对称性与步态生物力学的关系。我们假设，随着股四头肌力量对称性的增加，运动员将表现出更多的对称性膝关节生物力学，包括步态中的胫股关节负荷。横断面研究。在79名参加前交叉韧带运动的运动员中，76人在完成术后康复和10次重返运动训练后(ACLR后7.1±2.0个月)参加了这项研究。所有参与者都完成了生物力学步行步态分析和使用机电测功机进行的股四头肌等长力量评估。股四头肌力量用肢体对称性指数(患肢/非患肢x 100%)计算。感兴趣的生物力学变量包括：最大膝关节屈曲角(PKFA)、最大膝关节内伸力矩、承重和站立中时膝关节矢状面偏移量、PKFA时股四头肌肌力和最大内侧筋膜间接触力。采用Spearman‘s Rho(ρ)相关系数分别确定肢体对称性指数股四头肌力量与各生物力学变量之间的关系，α设为0.05。在76名参与者中，27名(35%)表现出股四头肌力量不对称，定义为股四头肌力量对称性90%(n=23)或110%(n=4)(QI范围：56.9%-131.7%)。在感兴趣的生物力学变量中，67%的膝关节峰值屈曲角不对称，68%和83%的膝关节在承重和中立时的膝关节漂移不对称，74%的膝关节伸展峰值时刻不对称，57%的膝关节内侧间隙接触力不对称，74%的股四头肌肌力不对称。回归运动训练后，在任何生物力学变量中，股四头肌力量指数和肢体对称性指数之间没有显著的相关性(p>；0.129)。在前交叉韧带重建后完成回归运动训练的患者中，随后的股四头肌力量对称性与步态生物力学中持续的不对称性无关。在达到股四头肌力量的阈值后，仅恢复力量可能不能改善步态不对称，目前的临床干预和回归运动训练可能不足以达到步态的目标。@elanna_arhos，@doclsmack，@JacobCapin的研究表明，在ACLR术后康复良好的人中，股四头肌力量与对称步态机制无关。开发针对步态的干预措施可能是减轻ACLR后异常步态机制的关键一步。
After anterior cruciate ligament reconstruction, biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with pre-operative gait asymmetries and post-operative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to pre-operative and early rehabilitation time points prior to return-to-sport training. To determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after anterior cruciate ligament reconstruction. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics including tibiofemoral joint loading during gait. Cross-sectional study. Seventy-six of 79 athletes enrolled in ACL-SPORTS were participants for this study after completing post-operative rehabilitation and 10 return-to-sport training sessions (7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value/ uninvolved limb value x 100%). The biomechanical variables of interest included: peak knee flexion angle (PKFA), peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and mid-stance, quadriceps muscle force at PKFA, and peak medial compartment contact force. Spearman’s rho (ρ) correlation coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable separately; alpha was set to 0.05. Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n=23) or >110% (n=4) (QI range: 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle, 68% and 83% in knee excursion during weight acceptance and midstance, respectively, 74% in internal peak knee extension moment, 57% in medial compartment contact force, and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable following return-to-sport training (p>0.129). Among those who completed return-to-sport training after ACL reconstruction, subsequent quadriceps strength symmetry is not correlated with the persistent asymmetries in gait biomechanics. After reaching a threshold of quadriceps strength, restoring strength alone may not ameliorate gait asymmetries and current clinical interventions and return-to-sport training may not adequately target gait. Work from @elanna_arhos, @doclsmack, @JacobCapin suggests that in those well rehabilitated after ACLR, quadriceps strength is not related to symmetric gait mechanics. Developing gait-specific interventions may be a critical step to mitigating aberrant gait mechanics after ACLR.
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影响因子：
3.3
作者：
Arundale, Amelia J. H.;Capin, Jacob J.;Snyder-Mackler, Lynn
通讯作者：
Snyder-Mackler, Lynn
影响因子：
1.8
作者：
Di Stasi, Stephanie L.;Snyder-Mackler, Lynn
通讯作者：
Snyder-Mackler, Lynn
影响因子：
2.8
作者：
Capin, Jacob J.;Zarzycki, Ryan;Snyder-Mackler, Lynn
通讯作者：
Snyder-Mackler, Lynn
DOI：
10.2106/00004623-199808000-00006
发表时间：
1998-08-01
影响因子：
5.3
作者：
Irrgang, JJ;Snyder-Mackler, L;Harner, CD
通讯作者：
Harner, CD
影响因子：
2.4
作者：
Andriacchi, TP;Dyrby, CO
通讯作者：
Dyrby, CO