Palmieri-Smith Riann M, Lepley Lindsey K
School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA.
Am J Sports Med. 2015 Jul;43(7):1662-9. doi: 10.1177/0363546515578252. Epub 2015 Apr 16.
Quadriceps strength deficits are observed clinically after anterior cruciate ligament (ACL) injury and reconstruction and are often not overcome despite rehabilitation. Given that quadriceps strength may be important for achieving symmetrical joint biomechanics and promoting long-term joint health, determining the magnitude of strength deficits that lead to altered mechanics is critical.
To determine if the magnitude of quadriceps strength asymmetry alters knee and hip biomechanical symmetry as well as functional performance and self-reported function.
Cross-sectional study; Level of evidence, 3.
A total of 73 patients were tested at the time they were cleared for return to activity after ACL reconstruction. Quadriceps strength and activation, scores on the International Knee Documentation Committee form, the hop for distance test, and sagittal plane lower extremity biomechanics were recorded while patients completed a single-legged hop.
Patients with high and moderate quadriceps strength symmetry had larger central activation ratios as well as greater limb symmetry indices on the hop for distance compared with patients with low quadriceps strength symmetry (P < .05). Similarly, knee flexion angle and external moment symmetry were higher in the patients with high and moderate quadriceps symmetry compared with those with low symmetry (P < .05). Quadriceps strength was found to be associated with sagittal plane knee angle and moment symmetry (P < .05).
Patients with low quadriceps strength displayed greater movement asymmetries at the knee in the sagittal plane. Quadriceps strength was related to movement asymmetries and functional performance. Rehabilitation after ACL reconstruction needs to focus on maximizing quadriceps strength, which likely will lead to more symmetrical knee biomechanics.
前交叉韧带（ACL）损伤和重建后临床上可观察到股四头肌力量不足，尽管进行了康复训练，这种不足往往仍无法克服。鉴于股四头肌力量对于实现对称的关节生物力学和促进长期关节健康可能很重要，确定导致力学改变的力量不足程度至关重要。
确定股四头肌力量不对称的程度是否会改变膝关节和髋关节的生物力学对称性以及功能表现和自我报告的功能。
横断面研究；证据等级，3级。
共有73例患者在ACL重建后被批准恢复活动时接受测试。在患者完成单腿跳跃时，记录股四头肌力量和激活情况、国际膝关节文献委员会表格评分、跳远测试成绩以及矢状面下肢生物力学数据。
与股四头肌力量对称性低的患者相比，股四头肌力量对称性高和中等的患者在跳远测试中具有更高的中枢激活率以及更大的肢体对称指数（P <.05）。同样，与对称性低的患者相比，股四头肌对称性高和中等的患者的膝关节屈曲角度和外力矩对称性更高（P <.05）。发现股四头肌力量与矢状面膝关节角度和力矩对称性相关（P <.05）。
股四头肌力量低的患者在矢状面膝关节处表现出更大的运动不对称性。股四头肌力量与运动不对称性和功能表现相关。ACL重建后的康复需要专注于最大化股四头肌力量，这可能会导致更对称的膝关节生物力学。
