Mittlmeier T, Weiler A, Söhn T, Kleinhans L, Mollbach S, Duda G, Südkamp N P
Klinik für Unfall und Wiederherstellungschirurgie, Rehazentrum Virchow, Universitätsklinikum Charité, Medizinische Fakultät der Humboldt Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, Germany.
Clin Biomech (Bristol). 1999 Oct;14(8):576-84. doi: 10.1016/s0268-0033(99)00035-2.
It was hypothesized that testing of ambulatory function and more demanding activities were more appropriate predictors of dynamic knee function before and after reconstruction of the anterior cruciate ligament than conventional measures of functional evaluation. It was assumed that assessment of dynamic plantar pressure distribution would represent a practical tool for guidance of the rehabilitation process after anterior cruciate ligament reconstruction.
In a prospective study, 10 patients with isolated anterior cruciate deficiency were examined before and after replacement of the anterior cruciate (6, 12, 24 weeks) in a standardized technique.
Today, functional assessment following anterior cruciate ligament reconstruction relies on clinical examination supplemented by instrumented testing of knee laxity and on isokinetic evaluation of muscle performance. Gait analysis has not been used as a quantitative measure of rehabilitation progress after surgery.
All patients were subjected to the same physiotherapy protocol. The clinical results were documented using the International Knee Documentation Committee (IKDC) protocol and the degree of knee laxity by an instrumented anterior drawer test. Muscular performance was evaluated by isokinetic testing. Dynamic pedography (EMED-SF 4) was performed to compare the non-injured and the operated leg during level walking and while descending stairs.
Gait performance six weeks after surgery tended to be inferior to preoperative and late postoperative values. While the slight increase of maximum knee extensor torque in the operated leg and the improvement of the IKDC score during the rehabilitation period were not statistically significant, a significantly decreased gait asymmetry could be observed 12 weeks after surgery. The descending stairs test revealed functional deficits better than level walking. The latter test exhibited a strong correlation with the preoperative IKDC level and the maximum knee extensor deficit at 60 degrees /s.
Dynamic pedography during level walking and while descending stairs is a valuable tool for monitoring the rehabilitation process after anterior cruciate ligament reconstruction.
Due to the better resolution of functional deficits compared with indirect measures of function (isokinetic testing) assessment of the plantar pressure distribution may provide a more individualized adaptation for the rehabilitation program.
研究假设，相比于传统的功能评估方法，动态功能测试以及更具挑战性的活动测试能更准确地预测前交叉韧带重建前后的膝关节动态功能。研究还假定，动态足底压力分布评估可作为前交叉韧带重建术后康复过程指导的实用工具。
一项前瞻性研究，对10例单纯前交叉韧带损伤患者采用标准化技术在重建前交叉韧带（术后6周、12周、24周）前后进行检查。
目前，前交叉韧带重建术后的功能评估依赖于临床检查，辅助以膝关节松弛度的仪器测试以及肌肉功能的等速测试。步态分析尚未被用作手术后康复进展的定量指标。
所有患者均接受相同的物理治疗方案。使用国际膝关节文献委员会（IKDC）方案记录临床结果，通过仪器化前抽屉试验记录膝关节松弛度。通过等速测试评估肌肉功能。在平路行走和下楼梯时，采用动态足印图（EMED-SF 4）对健侧和手术侧下肢进行比较。
术后6周的步态表现往往低于术前和术后晚期水平。虽然手术侧下肢最大伸膝扭矩略有增加且康复期间IKDC评分有所改善，但差异无统计学意义，然而术后12周步态不对称性显著降低。下楼梯测试比平路行走更能显示功能缺陷。后者测试与术前IKDC水平和60度/秒时最大伸膝缺陷密切相关。
平路行走和下楼梯时的动态足印图是监测前交叉韧带重建术后康复过程的有价值工具。
与功能的间接测量方法（等速测试）相比，足底压力分布评估能更好地分辨功能缺陷，可为康复计划提供更个性化的调整。
