Lewek Michael, Rudolph Katherine, Axe Michael, Snyder-Mackler Lynn
Department of Physical Therapy, 301 McKinly Lab, University of Delaware, Newark, DE 19716, USA.
Clin Biomech (Bristol). 2002 Jan;17(1):56-63. doi: 10.1016/s0268-0033(01)00097-3.
To determine the effect of quadriceps strength and joint stability on gait patterns after anterior cruciate ligament injury and reconstruction.
Cross-sectional comparative study in which four groups underwent motion analysis with surface electromyography.
Individuals following anterior cruciate ligament rupture often demonstrate reduced knee angles and moments during the early stance phase of gait. Alterations in gait can neither be ascribed to instability nor to quadriceps weakness alone when both are present.
Twenty-eight individuals with complete anterior cruciate ligament rupture (10 patients with acute rupture, 8 patients following reconstruction with quadriceps strength >90% of the uninvolved side [strong-anterior cruciate ligament reconstructed group], and 10 patients after reconstruction with quadriceps strength <80% of the uninvolved side [weak-anterior cruciate ligament reconstructed group]), and 10 uninjured subjects underwent an examination of their lower extremity to collect kinematics, kinetics, and electromyography during walking and jogging. Anterior cruciate ligament reconstruction was arthroscopically assisted and a double loop semitendinosis-gracilis autograft or allograft was used as a graft source. All reconstructed subjects had stable knees, full range of motion, and no effusion or pain at the time of testing (more than three months after surgery).
Knee angles and moments of the strong group were indistinguishable from the uninjured group during early stance of both walking and jogging. The weak subjects had reduced knee angles and moments during walking, and jogged similarly to the deficient subjects. Regression analysis revealed a significant effect between early stance phase knee angles and moments and quadriceps strength during both walking and jogging.
Inadequate quadriceps strength contributes to altered gait patterns following anterior cruciate ligament reconstruction.
Rapid strengthening following anterior cruciate ligament injury or reconstruction may contribute to a safe return to high-level activities.
确定股四头肌力量和关节稳定性对前交叉韧带损伤及重建后步态模式的影响。
横断面比较研究，四组接受了表面肌电图的运动分析。
前交叉韧带断裂后的个体在步态的早期站立阶段通常表现出膝关节角度和力矩减小。当两者都存在时，步态改变既不能单独归因于不稳定，也不能单独归因于股四头肌无力。
28例前交叉韧带完全断裂的个体（10例急性断裂患者，8例重建后股四头肌力量>健侧90%的患者[强壮-前交叉韧带重建组]，10例重建后股四头肌力量<健侧80%的患者[虚弱-前交叉韧带重建组]），以及10例未受伤的受试者接受了下肢检查，以收集行走和慢跑时的运动学、动力学和肌电图数据。前交叉韧带重建采用关节镜辅助，使用双股半腱肌-股薄肌自体移植物或同种异体移植物作为移植物来源。所有重建受试者在测试时（手术后三个月以上）膝关节稳定、活动范围正常，无积液或疼痛。
在行走和慢跑的早期站立阶段，强壮组的膝关节角度和力矩与未受伤组无明显差异。虚弱组在行走时膝关节角度和力矩减小，慢跑时与缺陷组相似。回归分析显示，在行走和慢跑过程中，早期站立阶段膝关节角度和力矩与股四头肌力量之间存在显著影响。
股四头肌力量不足导致前交叉韧带重建后步态模式改变。
前交叉韧带损伤或重建后快速增强力量可能有助于安全恢复到高水平活动。
