Department of Orthopaedics and Traumatology, School of Medicine, University of Mersin, Mersin, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2011 Aug;19(8):1271-6. doi: 10.1007/s00167-011-1398-z. Epub 2011 Feb 3.
The metabolic energy cost of walking is altered by pathological changes in gait. It is thought that anterior cruciate ligament (ACL) deficiency alters the energy requirement for level walking through its effect on gait pattern. In this study, it is hypothesised that the metabolic energy cost of walking would improve after ACL reconstruction.
Eight patients who were undergoing ACL reconstruction for an isolated rupture were included in this prospective study. Clinical examinations, Lysholm scores and metabolic tests were performed preoperatively and at 3, 6 and 12 months after ACL reconstruction using autologous quadruple hamstring tendons. For the metabolic evaluation, net oxygen cost was calculated while walking on a treadmill at 50-, 70- and 90-m/min velocities. A two-way factorial ANOVA was performed in order to evaluate the primary effects and interactions of the time point and velocity variables on net oxygen cost.
All patients had positive Lachman and anterior drawer tests preoperatively that became negative postoperatively and remained negative until the last follow-up point. The mean preoperative Lysholm score was 66, whereas the mean postoperative follow-up scores were 85, 91 and 94, respectively. The interaction between follow-up time point and velocity was not significant. Regardless of the selected velocity, the net oxygen cost was lower than that at preoperative levels at each postoperative time point (p < 0.05).
The results of the present study indicate that the energy cost of level walking in chronic ACL-deficient patients improves after ACL reconstruction. Cause-effect-based studies with correlation evaluations that compare kinetic, kinematic and electromyographic data and metabolic cost calculations should facilitate more accurate analyses.
Therapeutic study, Level 4.
步态的病理变化会改变步行的代谢能量消耗。人们认为前交叉韧带（ACL）缺失会通过对步态模式的影响改变水平行走的能量需求。在这项研究中，假设 ACL 重建后步行的代谢能量消耗会改善。
本前瞻性研究纳入了 8 例因 ACL 撕裂而接受 ACL 重建的患者。临床检查、Lysholm 评分和代谢测试在 ACL 重建术前和术后 3、6 和 12 个月使用自体四股腘绳肌腱进行。对于代谢评估，在跑步机上以 50、70 和 90m/min 的速度行走时，计算净耗氧量。采用双因素方差分析评估时间点和速度变量对净耗氧量的主要影响和交互作用。
所有患者术前均有阳性的 Lachman 和前抽屉试验，术后转为阴性，直至最后随访点仍为阴性。术前平均 Lysholm 评分为 66，而术后随访评分分别为 85、91 和 94。随访时间点和速度之间的交互作用不显著。无论选择何种速度，术后每个时间点的净耗氧量均低于术前水平（p<0.05）。
本研究结果表明，ACL 缺失慢性患者的水平行走能量消耗在 ACL 重建后得到改善。基于因果关系的研究，结合动力学、运动学和肌电图数据以及代谢成本计算的相关性评估，将有助于更准确的分析。
治疗研究，等级 4。
