Nyland J A, Caborn D N M
Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray Street, Suite 1003, Louisville, KY 40202, USA.
Knee Surg Sports Traumatol Arthrosc. 2004 Jul;12(4):285-93. doi: 10.1007/s00167-003-0430-3. Epub 2003 Nov 15.
This study evaluated the ankle and knee electromyographic, kinematic, and kinetic differences of 20 nonimpaired females with either neutral (group 1) or coxa varus-genu valgus (group 2) alignment during crossover cutting stance phase. Two-way mixed model ANOVA (group, session) assessed mean differences ( p<0.05) and correlation analysis further delineated relationships. During impact absorption, group 2 displayed earlier peak horizontal braking (anterior-posterior) ground reaction force timing, decreased and earlier peak internal knee extension moments (eccentric function), and earlier peak internal ankle dorsiflexion moment timing (eccentric function). During the pivot phase, group 2 displayed later and eccentrically-biased peak ankle plantar flexion moments, increased peak internal knee flexion moments (eccentric function), and later peak knee internal rotation timing. Correlation analysis revealed that during impact absorption, subjects with coxa varus-genu valgus alignment (group 2) displayed a stronger relationship between knee internal rotation velocity and peak internal ankle dorsiflexion moment onset timing ( r= -0.64 vs r = -0.26) and between peak horizontal braking ground reaction forces and peak internal ankle dorsiflexion moment onset timing ( r= 0.61 vs r= 0.24). During the pivot phase these subjects displayed a stronger relationship between peak horizontal braking ground reaction forces and peak internal ankle plantar flexion moment onset timing ( r= -0.63 vs r= -0.09) and between peak horizontal braking forces and peak internal ankle plantar flexion moments ( r= -0.72 vs r= -0.26). Group differences suggest that subjects with coxa varus-genu valgus frontal-plane alignment have an increased dependence on both ankle dorsiflexor and plantar flexor muscle group function during crossover cutting. Greater dependence on ankle muscle group function during the performance of a task that requires considerable 3D dynamic knee joint control suggests a greater need for frontal and transverse plane weight bearing tasks that facilitate eccentric ankle muscle group function to optimize injury prevention conditioning and post-surgical rehabilitation programs.
本研究评估了20名无损伤女性在交叉切入站立阶段，中立位（第1组）或髋内翻-膝外翻（第2组）对线情况下的踝关节和膝关节肌电图、运动学及动力学差异。双向混合模型方差分析（组、试验）评估均值差异（p<0.05），相关分析进一步阐明关系。在冲击吸收阶段，第2组表现出更早的水平制动（前后向）地面反作用力峰值出现时间、降低且更早的膝关节内伸肌峰值力矩（离心功能）以及更早的踝关节背屈肌峰值力矩出现时间（离心功能）。在枢转阶段，第2组表现出更晚且偏向离心的踝关节跖屈峰值力矩、增加的膝关节内屈肌峰值力矩（离心功能）以及更晚的膝关节内旋出现时间。相关分析显示，在冲击吸收阶段，髋内翻-膝外翻对线的受试者（第2组）在膝关节内旋速度与踝关节背屈肌峰值力矩起始时间之间（r = -0.64 vs r = -0.26）以及水平制动地面反作用力峰值与踝关节背屈肌峰值力矩起始时间之间（r = 0.61 vs r = 0.24）呈现出更强的相关性。在枢转阶段，这些受试者在水平制动地面反作用力峰值与踝关节跖屈肌峰值力矩起始时间之间（r = -0.63 vs r = -0.09）以及水平制动力峰值与踝关节跖屈肌峰值力矩之间（r = -0.72 vs r = -0.26）呈现出更强的相关性。组间差异表明，髋内翻-膝外翻额状面的受试者在交叉切入时对踝关节背屈肌和跖屈肌肌群功能的依赖性增加。在需要大量三维动态膝关节控制的任务执行过程中，对踝关节肌群功能的更大依赖性表明，对于促进踝关节肌群离心功能以优化损伤预防训练和术后康复计划的额状面和横断面负重任务有更大需求。
