Hart Joseph M, Kuenze Christopher M, Diduch David R, Ingersoll Christopher D
University of Virginia, Charlottesville;
J Athl Train. 2014 Nov-Dec;49(6):733-9. doi: 10.4085/1062-6050-49.3.39.
Persistent muscle weakness after anterior cruciate ligament (ACL) reconstruction may be due to underlying activation failure and arthrogenic muscle inhibition (AMI). Knee-joint cryotherapy has been shown to improve quadriceps function transiently in those with AMI, thereby providing an opportunity to improve quadriceps muscle activation and strength in patients with a reconstructed ACL.
To compare quadriceps muscle function in patients with a reconstructed ACL who completed a 2-week intervention including daily cryotherapy (ice bag), daily exercises, or both.
Cross-sectional study.
Laboratory.
A total of 30 patients with reconstructed ACLs who were at least 6 months post-index surgery and had measurable quadriceps AMI.
INTERVENTION(S): The patients attended 4 supervised visits over a 2-week period. They were randomly assigned to receive 20 minutes of knee-joint cryotherapy, 1 hour of therapeutic rehabilitation exercises, or cryotherapy followed by exercises.
MAIN OUTCOME MEASURE(S): We measured quadriceps Hoffmann reflex, normalized maximal voluntary isometric contraction torque, central activation ratio using the superimposed-burst technique, and patient-reported outcomes before and after the intervention period.
After the 2-week intervention period, patients who performed rehabilitation exercises immediately after cryotherapy had higher normalized maximal voluntary isometric contraction torques (P = .002, Cohen d effect size = 1.4) compared with those who received cryotherapy alone (P = .16, d = 0.58) or performed exercise alone (P = .16, d = 0.30).
After ACL reconstruction, patients with AMI who performed rehabilitation exercises immediately after cryotherapy experienced greater strength gains than those who performed cryotherapy or exercises alone.
前交叉韧带（ACL）重建术后持续存在的肌肉无力可能是由于潜在的激活失败和关节源性肌肉抑制（AMI）。膝关节冷冻疗法已被证明可使AMI患者的股四头肌功能得到短暂改善，从而为改善ACL重建患者的股四头肌激活和力量提供了机会。
比较完成为期2周干预（包括每日冷冻疗法（冰袋）、每日锻炼或两者皆有）的ACL重建患者的股四头肌功能。
横断面研究。
实验室。
总共30例ACL重建患者，这些患者至少在初次手术后6个月且有可测量的股四头肌AMI。
患者在2周内参加4次监督下的访视。他们被随机分配接受20分钟的膝关节冷冻疗法、1小时的治疗性康复锻炼或冷冻疗法后进行锻炼。
我们在干预期前后测量了股四头肌霍夫曼反射、标准化最大自主等长收缩扭矩、使用叠加爆发技术的中枢激活率以及患者报告的结局。
在为期2周的干预期后，与单独接受冷冻疗法（P = 0.16，d = 0.58）或单独进行锻炼（P = 0.16，d = 0.30）的患者相比，冷冻疗法后立即进行康复锻炼的患者具有更高的标准化最大自主等长收缩扭矩（P = 0.002，科恩d效应量 = 1.4）。
ACL重建后，AMI患者在冷冻疗法后立即进行康复锻炼比单独进行冷冻疗法或锻炼的患者力量增加更大。
