Neeter Camille, Gustavsson Alexander, Thomeé Pia, Augustsson Jesper, Thomeé Roland, Karlsson Jon
Lundberg Laboratory for Orthopaedic Research, Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, 413 45, Göteborg, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2006 Jun;14(6):571-80. doi: 10.1007/s00167-006-0040-y. Epub 2006 Feb 14.
A more sports-specific and detailed strength assessment has been advocated for patients after anterior cruciate ligament (ACL) injury and reconstruction. The purpose of this study was to develop a test battery of lower extremity strength tests with high ability to discriminate between leg power development on the injured and uninjured sides in patients after ACL injury and in patients who have undergone ACL reconstruction. Twenty-three patients were tested 6 months after ACL injury and 44 patients were tested 6 months after ACL reconstruction. Twenty-four of the 44 patients were operated on using a hamstrings graft and 20 patients were operated on using a patellar tendon graft. All the patients performed a test battery of three strength tests for each leg in a randomised order. The three strength tests were chosen to reflect quadriceps and hamstring muscular power in a knee-extension and a knee-flexion test (open kinetic chain) and lower-extremity muscular power in a leg-press test (closed kinetic chain). There was a higher sensitivity for the test battery to discriminate abnormal leg power compared with any of the three strength tests individually. Nine out of ten patients after ACL reconstruction and six out of ten of the patients after ACL injury exhibited abnormal leg power symmetry using the test battery. Thus, this test battery had high ability in terms of discriminating between the leg power performance on the injured and uninjured side, both in patients with an ACL injury and in patients who have undergone ACL reconstruction. It is concluded that a test battery consisting of a knee-extension, knee-flexion and leg-press muscle power test had high ability to determine deficits in leg power 6 months after ACL injury and reconstruction. Only a minority of the patients had restored leg muscle power. The clinical relevance is that the test battery may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities after an ACL injury or reconstruction.
对于前交叉韧带（ACL）损伤和重建后的患者，有人主张进行更具运动针对性和详细的力量评估。本研究的目的是开发一套下肢力量测试组合，该组合具有较高的能力，能够区分ACL损伤患者和接受ACL重建患者受伤侧与未受伤侧的腿部力量发展情况。23例患者在ACL损伤后6个月接受测试，44例患者在ACL重建后6个月接受测试。44例患者中有24例采用腘绳肌移植物进行手术，20例患者采用髌腱移植物进行手术。所有患者均以随机顺序对每条腿进行三项力量测试的组合测试。选择这三项力量测试是为了在膝关节伸展和膝关节屈曲测试（开链运动）中反映股四头肌和腘绳肌的肌肉力量，以及在腿举测试（闭链运动）中反映下肢肌肉力量。与任何一项单独的力量测试相比，该测试组合区分异常腿部力量的敏感性更高。使用该测试组合，ACL重建后十分之九的患者和ACL损伤后十分之六的患者表现出腿部力量对称性异常。因此，无论是ACL损伤患者还是接受ACL重建的患者，该测试组合在区分受伤侧和未受伤侧的腿部力量表现方面都具有很高的能力。得出的结论是，由膝关节伸展、膝关节屈曲和腿举肌肉力量测试组成的测试组合，在确定ACL损伤和重建后6个月腿部力量缺陷方面具有很高的能力。只有少数患者恢复了腿部肌肉力量。其临床意义在于，在决定ACL损伤或重建后的患者是否以及何时能够安全地恢复剧烈体育活动时，该测试组合可能有助于决策过程。
