Birmingham T B, Kramer J F, Kirkley A, Inglis J T, Spaulding S J, Vandervoort A A
Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada.
Med Sci Sports Exerc. 2001 Aug;33(8):1253-8. doi: 10.1097/00005768-200108000-00002.
To evaluate the effects an anterior cruciate ligament (ACL) brace has on various measures of knee proprioception and postural control.
Thirty subjects (mean age 27 +/- 11 yr) having undergone unilateral ACL reconstruction were tested with and without wearing their own custom-fit brace on their involved limb. Proprioception was assessed using joint angle replication tests completed on an isokinetic dynamometer. Postural control was assessed using a series of single-limb standing balance tests completed on a force platform. The balance tests included: 1) standing on the stable platform with eyes open, 2) standing on a foam mat placed over the platform with eyes open, 3) standing on the platform with eyes closed, and 4) standing on the platform after landing from a maximal single-limb forward hop.
The brace provided a small but statistically significant improvement in proprioception (mean reduction in error scores between target and reproduced angles = 0.64 +/- 1.4 degrees, P = 0.02). For the postural control tests, there was a significant brace condition by test situation interaction (P = 0.02), with the brace providing a small but statistically significant improvement during the test completed on the stable platform with eyes open (mean reduction in center of pressure path length = 4.2 +/- 8.4 cm, P = 0.02) but not during the other more challenging test situations. Additional post hoc analyses indicated that the relationship between knee proprioception and postural control measures were low and not significant (r = 0.003 to 0.19, P > 0.32), consistent with the suggestion that changes in knee proprioception can occur in the absence of substantial changes in postural control. Also, standing balance tests that challenged the somatosensory contribution to postural control (i.e., those completed on foam, or with eyes closed) were significantly related to single-limb forward hop distances (r = -0.4, P < 0.05), whereas performance during the proprioception test was not (r = 0.1, P > 0.50).
In general, bracing appears to improve performance during tasks characterized by relatively limited somatosensory input but not during tasks characterized by increased somatosenory input. The small magnitude of the improvements, coupled with their apparent lack of carry over to more difficult and functionally relevant tasks, questions the clinical benefit of the present effects of bracing.
评估前交叉韧带（ACL）支具对膝关节本体感觉和姿势控制各项指标的影响。
对30名（平均年龄27±11岁）接受单侧ACL重建的受试者，在患侧肢体佩戴和不佩戴定制支具的情况下进行测试。使用在等速测力计上完成的关节角度复制测试来评估本体感觉。使用在测力平台上完成的一系列单腿站立平衡测试来评估姿势控制。平衡测试包括：1）睁眼站在稳定平台上；2）睁眼站在平台上放置的泡沫垫上；3）闭眼站在平台上；4）单腿最大向前跳跃落地后站在平台上。
支具在本体感觉方面有小但具有统计学意义的改善（目标角度与复制角度之间误差分数的平均降低 = 0.64±1.4度，P = 0.02）。对于姿势控制测试，测试情况与支具状况之间存在显著交互作用（P = 0.02），支具在睁眼站在稳定平台上完成的测试中提供了小但具有统计学意义的改善（压力中心路径长度的平均降低 = 4.2±8.4厘米，P = 0.02），但在其他更具挑战性的测试情况中没有。额外的事后分析表明，膝关节本体感觉与姿势控制指标之间的关系较低且不显著（r = 0.003至0.19，P>0.32），这与膝关节本体感觉变化可在姿势控制无实质性变化的情况下发生的观点一致。此外，挑战本体感觉对姿势控制贡献的站立平衡测试（即那些在泡沫上或闭眼完成的测试）与单腿向前跳跃距离显著相关（r = -0.4，P <0.05），而本体感觉测试期间的表现则不然（r = 0.1，P>0.50）。
总体而言，支具似乎在以相对有限的本体感觉输入为特征的任务中提高表现，但在以增加的本体感觉输入为特征的任务中则不然。改善幅度较小，再加上它们显然没有延续到更困难和功能相关的任务中，这对支具当前效果的临床益处提出了质疑。
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