Salem George J, Salinas Ruben, Harding F Victor
Musculoskeletal Biomechanics Research Laboratory, Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA.
Arch Phys Med Rehabil. 2003 Aug;84(8):1211-6. doi: 10.1016/s0003-9993(03)00034-0.
To characterize the bilateral lower-extremity kinematics and kinetics associated with squatting exercise after anterior cruciate ligament (ACL) reconstruction.
We evaluated bilaterally sagittal plane kinematics and kinetics of the ankle, knee, and hip joints during submaximal squatting exercise in rehabilitating patients after ACL reconstruction. Comparisons were performed between involved and noninvolved limbs, and regression models were created to examine the relations between the bilateral kinetic differences and time postsurgery.
A motion analysis laboratory.
Eight adults (27.9+/-6.8y) with unilateral ACL reconstruction (postsurgical time, 30+/-12wk).
Not applicable.
Sagittal plane ankle, knee, and hip peak net moments of force, maximum joint excursion angles, and peak vertical ground reaction forces.
Peak vertical ground reaction forces did not differ between limbs. The peak knee extensor moment generated during the submaximal squatting exercise was 25.5% greater in the noninvolved limb than in the involved limb (P=.003). The peak ankle plantarflexor moment did not differ between limbs (P=.85); however, there was a trend toward a greater hip extensor moment in the involved limb (P=.06). The ratio of the peak hip extensor moment to the peak knee extensor moment was 46.5% greater in the involved limb (P=.02). Only the peak dorsiflexion angle differed between limbs (P=.02). None of the linear models examining the relations between differences in the involved limb and noninvolved limb kinetics, and postsurgical time, were statistically significant.
Patients performing the squat exercise, within 1 year of ACL reconstructive surgery, used 2 strategies for generating the joint torques required to perform the movement: (1) in the noninvolved limb, patients used a strategy that equally distributed the muscular effort between the hip and knee extensors, and (2) in the involved limb, patients used a strategy that increased the muscular effort at the hip and reduced the effort at the knee. These intra- and interlimb motor-programming alterations (ie, substitution strategies) could potentially slow or limit rehabilitation, and induce strength and performance deficits.
描述前交叉韧带(ACL)重建术后深蹲运动相关的双侧下肢运动学和动力学特征。
我们评估了ACL重建术后康复患者在次最大深蹲运动过程中双侧踝关节、膝关节和髋关节矢状面的运动学和动力学情况。对患侧和非患侧肢体进行了比较,并建立了回归模型以研究双侧动力学差异与术后时间之间的关系。
一个运动分析实验室。
8名单侧ACL重建的成年人(27.9±6.8岁)(术后时间为30±12周)。
不适用。
矢状面踝关节、膝关节和髋关节的峰值净力矩、最大关节活动角度以及峰值垂直地面反作用力。
双侧肢体的峰值垂直地面反作用力无差异。在次最大深蹲运动过程中,非患侧肢体产生的峰值膝关节伸肌力矩比患侧肢体大25.5%(P = 0.003)。双侧肢体的峰值踝关节跖屈力矩无差异(P = 0.85);然而,患侧肢体的髋关节伸肌力矩有增大趋势(P = 0.06)。患侧肢体的峰值髋关节伸肌力矩与峰值膝关节伸肌力矩之比比非患侧肢体大46.5%(P = 0.02)。仅双侧肢体的峰值背屈角度存在差异(P = 0.02)。研究患侧和非患侧肢体动力学差异与术后时间之间关系的线性模型均无统计学意义。
在ACL重建手术后1年内进行深蹲运动的患者,采用两种策略来产生完成该动作所需的关节扭矩:(1)在非患侧肢体,患者采用一种在髋关节和膝关节伸肌之间平均分配肌肉力量的策略;(2)在患侧肢体,患者采用一种增加髋关节肌肉力量并减少膝关节肌肉力量的策略。这些肢体内部和肢体间的运动程序改变(即替代策略)可能会潜在地减缓或限制康复进程,并导致力量和运动表现缺陷。