Division of Occupational and Physical Therapy, Sports Medicine Biodynamics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
J Orthop Sports Phys Ther. 2011 Aug;41(8):553-9. doi: 10.2519/jospt.2011.3591. Epub 2011 Aug 1.
Controlled laboratory, cross-sectional, cohort design.
To determine if a sex-specific pattern of lower limb asymmetries is present during a drop vertical jump (DVJ) maneuver at the time of return to sport after anterior cruciate ligament (ACL) reconstruction.
A high incidence of second ACL injury is reported after reconstruction; however, the underlying mechanisms of this injury are unclear. While asymmetrical dynamic loading patterns predictive of primary ACL injury in healthy female athletes were observed in female athletes 2 years after ACL reconstruction, it is unknown if similar asymmetries are present in male athletes after ACL reconstruction at the time of return to sport.
A total of 98 participants were included in the study, 56 of whom had unilateral ACL reconstruction (35 female, 21 male) and had been released to return to unrestricted level 1 and 2 sports, and 42 of whom were uninjured, activity-matched control participants (29 female, 13 male). Lower extremity kinetic data were analyzed during a bilateral drop vertical jump maneuver from a 31-cm box. Peak vertical ground reaction force (VGRF) was calculated during the landing phase of the drop vertical jump and normalized to body weight (BW). A 2-by-2-by-2 analysis of variance was used to determine differences between side (involved versus uninvolved), group (ACL reconstruction versus control), and sex (female versus male) for the peak VGRF.
A significant side-by-group interaction for peak VGRF (P = .002) was observed during the landing phase of the drop vertical jump in the entire cohort. The involved limb of the ACL reconstructed group displayed significantly lower VGRF (mean ± SD, 1.77 ± 0.35 BW) than the uninvolved limb (2.2 ± 0.4 BW, P<.001) and both the preferred limb (2.0 ± 0.4 BW, P = .002) and nonpreferred limb (2.09 ± 0.42 BW, P<.001) in the control group. No effect of sex was noted.
After ACL reconstruction, both male and female participants at the time of return to sport demonstrated involved limb asymmetries in peak VGRF during landing from a bipedal task. These deficits, which persist at the time of return to sport, may increase the risk of future injury and indicate that rehabilitation after ACL reconstruction may require more targeted interventions to address involved limb biomechanical deficits in athletes of both sexes prior to return to sport participation.
对照实验室、横断面、队列设计。
确定在前交叉韧带（ACL）重建后重返运动时，在进行垂直跳落（DVJ）动作时，下肢是否存在特定的不对称模式。
据报道，ACL 重建后二次 ACL 损伤的发生率较高；然而，这种损伤的潜在机制尚不清楚。尽管在 ACL 重建后 2 年的健康女性运动员中观察到了预测原发性 ACL 损伤的不对称动态负荷模式，但尚不清楚男性运动员在重返运动时是否存在类似的不对称现象。
本研究共纳入 98 名参与者，其中 56 名接受了单侧 ACL 重建（35 名女性，21 名男性），并已获准重返无限制的 1 级和 2 级运动，42 名未受伤的、活动匹配的对照组参与者（29 名女性，13 名男性）。在从 31 厘米高的箱子上进行双侧垂直跳落动作时，分析下肢动力学数据。在垂直跳落的着陆阶段计算垂直地面反作用力（VGRF）的峰值，并将其归一化为体重（BW）。使用 2 乘 2 乘 2 的方差分析来确定在整个队列的垂直跳落着陆阶段，侧（受累与未受累）、组（ACL 重建与对照组）和性别（女性与男性）之间的峰值 VGRF 差异。
在整个队列的垂直跳落着陆阶段，观察到峰值 VGRF 的侧-组交互作用具有显著意义（P=.002）。ACL 重建组的受累侧的 VGRF 明显低于未受累侧（平均±标准差，1.77±0.35 BW），也明显低于对照组的优势侧（2.0±0.4 BW，P=.002）和非优势侧（2.09±0.42 BW，P<.001）。未观察到性别的影响。
在 ACL 重建后，重返运动时的男性和女性参与者在从双足任务着陆时，受累侧的峰值 VGRF 都表现出不对称性。这些在重返运动时仍然存在的缺陷可能会增加未来受伤的风险，并表明 ACL 重建后的康复可能需要更有针对性的干预措施，以解决男女运动员重返运动前受累侧的生物力学缺陷。
