Knoll Zsolt, Kiss Rita M, Kocsis László
MEDICaMENTOR Foundation, Pálos u. 3., 1021 Budapest, Hungary.
J Electromyogr Kinesiol. 2004 Jun;14(3):287-94. doi: 10.1016/j.jelekin.2003.12.005.
The objective of this study is to determine how kinematical parameters and electromyography data of selected muscles may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was conducted on 25 anterior cruciate ligament deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months following ACL reconstructive surgery using the bone-patellar tendon-bone technique. Gait analysis was performed by applying the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris). Kinematic data were recorded for the lower limb. The muscles surveyed include vastus lateralis and medialis, biceps femoris and adductor longus. The results obtained from the injured subjects were compared with those of 51 individuals without any ACL damage whatsoever. Acute ACL deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks following surgery. No quadriceps avoidance phenomenon develops in chronic ACL deficient patients. In operated individuals, tempo-spatial parameters and the knee angle regained a normal pattern for the ACL-deficient limb during gait as early as 4 months following surgery. However, the relative ACL movement parameter, which describes the tibial translation into the direction of ACL, and the EMG traces show no significant statistical difference compared with the same values of the healthy control group just 8 months following surgery. The analysis of spatial-temporal parameters and EMG traces show that the development of a quadriceps avoidance pattern is less common than previously reported. These data suggest that anterior cruciate ligament deficiency and reconstruction produce considerable changes in the lower extremity gait pattern. The results suggest that gait parameters tend to shift towards a normal value pattern; and the re-establishment of pre-injury gait patterns-including the normal biphase of muscles-takes at least 8 months to occur.
本研究的目的是确定所选肌肉的运动学参数和肌电图数据如何因前交叉韧带（ACL）损伤以及ACL重建而发生变化。本研究对25名前交叉韧带损伤患者在ACL重建手术（采用骨-髌腱-骨技术）前以及术后6周、4个月、8个月和12个月进行。使用zebris三维超声表面肌电图系统（zebris）进行步态分析。记录下肢的运动学数据。所检测的肌肉包括股外侧肌和股内侧肌、股二头肌和长收肌。将受伤患者的结果与51名无任何ACL损伤的个体的结果进行比较。急性ACL损伤患者在手术前及术后6周表现出股四头肌回避模式。慢性ACL损伤患者未出现股四头肌回避现象。在接受手术的个体中，早在术后4个月，ACL损伤肢体在步态中的时空参数和膝关节角度就恢复了正常模式。然而，描述胫骨向ACL方向平移的相对ACL运动参数以及肌电图轨迹与健康对照组在术后仅8个月时的相同值相比，无显著统计学差异。对时空参数和肌电图轨迹的分析表明，股四头肌回避模式的发生率比之前报道的要低。这些数据表明，前交叉韧带损伤和重建会使下肢步态模式产生相当大的变化。结果表明，步态参数倾向于向正常值模式转变；包括肌肉正常双相性在内的损伤前步态模式的重新建立至少需要8个月时间。
