Ageberg Eva, Roos Harald P, Silbernagel Karin Grävare, Thomeé Roland, Roos Ewa M
Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund University Hospital, Lund 221 85, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2009 Feb;17(2):162-9. doi: 10.1007/s00167-008-0645-4. Epub 2008 Nov 4.
Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed up to 2 years post surgery, but not later. In these studies, isokinetic muscle torque was used. However, muscle power has been suggested to be a more sensitive and sport-specific measures of strength. The aim was to study quadriceps and hamstring muscle power in patients with ACL injury treated with surgical reconstruction with PT or HT grafts at a mean of 3 years after surgery. Twenty subjects with PT and 16 subjects with HT grafts (mean age at follow up 30 years, range 20-39, 25% women), who were all included in a prospective study and followed the same goal-based rehabilitation protocol for at least 4 months, were assessed with reliable, valid, and responsive tests of quadriceps and hamstring muscle power at 3 years (SD 0.9, range 2-5) after surgery. The mean difference between legs (injured minus uninjured), the hamstring to quadriceps (H:Q, hamstring divided by quadriceps) ratio, and the limb symmetry index (LSI, injured leg divided by uninjured and multiplied by 100) value, were used for comparisons between the groups (analysis of variance). The mean difference between the injured and uninjured legs was greater in the HT than in the PT group for knee flexion power (-21.3 vs. 7.7 W, p = 0.001). Patients with HT graft had lower H:Q ratio in the injured leg than the patients with PT graft (0.63 vs. 0.77, p = 0.012). They also had lower LSI for knee flexion power than those in the PT group (88 vs. 106%, p < 0.001). No differences were found between the groups for knee extension power. The lower hamstring muscle power, and the lower hamstring to quadriceps ratio in the HT graft group than in the PT graft group 3 years (range 2-5) after ACL reconstruction, reflect imbalance of knee muscles after reconstruction with HT graft that may have a negative effect on dynamic knee-joint stabilization.
腘绳肌在前交叉韧带(ACL)损伤后的膝关节稳定中起主要作用。在使用髌腱(PT)移植进行ACL重建后,膝关节伸肌会出现无力;而在使用腘绳肌腱(HT)移植进行重建后,膝关节屈肌在术后长达2年的时间里也会出现无力,但之后不会出现。在这些研究中,使用了等速肌肉扭矩。然而,肌肉力量被认为是一种更敏感且针对运动的力量测量指标。本研究的目的是在平均术后3年,对接受PT或HT移植手术重建治疗的ACL损伤患者的股四头肌和腘绳肌力量进行研究。20例接受PT移植和16例接受HT移植的受试者(随访时平均年龄30岁,范围20 - 39岁,25%为女性),他们均被纳入一项前瞻性研究,并遵循相同的基于目标的康复方案至少4个月,在术后3年(标准差0.9,范围2 - 5)通过可靠、有效且灵敏的测试对股四头肌和腘绳肌力量进行评估。使用双腿之间的平均差异(患侧减去健侧)、腘绳肌与股四头肌比值(H:Q,腘绳肌除以股四头肌)以及肢体对称指数(LSI,患侧腿除以健侧腿再乘以100)值进行组间比较(方差分析)。对于膝关节屈曲力量,HT组患侧与健侧腿之间的平均差异大于PT组(-21.3 vs. 7.7 W,p = 0.001)。接受HT移植的患者患侧腿的H:Q比值低于接受PT移植的患者(0.63 vs. 0.77,p = 0.012)。他们膝关节屈曲力量的LSI也低于PT组(88 vs. 106%,p < 0.001)。两组在膝关节伸展力量方面未发现差异。ACL重建术后3年(范围2 - 5),HT移植组的腘绳肌力量较低,且腘绳肌与股四头肌的比值也低于PT移植组,这反映出HT移植重建后膝关节肌肉失衡,可能会对膝关节动态稳定产生负面影响。