Perraton Luke, Clark Ross, Crossley Kay, Pua Yong-Hao, Whitehead Tim, Morris Hayden, Telianidis Stacey, Bryant Adam
Centre for Health, Exercise and Sports Medicine, Melbourne School of Physiotherapy, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
School of Exercise Science, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
Knee Surg Sports Traumatol Arthrosc. 2017 May;25(5):1424-1431. doi: 10.1007/s00167-015-3937-5. Epub 2016 Jan 8.
Impairments in quadriceps force control and altered quadriceps and hamstring muscle activation strategies have been observed following anterior cruciate ligament reconstruction; however, the functional implications of these impairments are unclear. This study examined the cross-sectional associations between quadriceps force control, quadriceps activation, hamstring coactivation and clinically assessed knee function following anterior cruciate ligament reconstruction with a hamstring graft.
Sixty-six patients (18 ± 3 months following surgery) and 41 uninjured individuals participated. Quadriceps force control was assessed using an isometric knee extension task. Participants cyclically increased and decreased quadriceps force at slow speeds between 5 and 30 % maximum voluntary isometric contraction matching a moving target displayed on a screen. Quadriceps activation and hamstring coactivation were assessed concurrently using surface electromyography. Knee function was assessed with the Cincinnati Knee Rating Scale and three single-leg hop tests.
The reconstructed group completed the task with 48 % greater root-mean-square error (RMSE), indicating significantly worse quadriceps force control (p < 0.001). In a multivariable model adjusted for sex, greater RMSE and greater lateral hamstring coactivation were significantly associated with worse knee function that is greater odds of scoring <85 % on one or more knee functional assessment.
Less-accurate quadriceps force output and greater hamstring coactivation are associated with worse knee joint function following anterior cruciate ligament reconstruction and may contribute to irregular knee joint loading and the onset or progression of knee osteoarthritis. Impairments in quadriceps force control and altered muscle activation strategies may be modifiable through neuromuscular training, and this is an area for future research.
Case-control study, Level III.
在前交叉韧带重建术后，已观察到股四头肌力量控制受损以及股四头肌和腘绳肌肌肉激活策略改变；然而，这些损伤的功能影响尚不清楚。本研究探讨了采用腘绳肌移植物进行前交叉韧带重建术后，股四头肌力量控制、股四头肌激活、腘绳肌协同激活与临床评估的膝关节功能之间的横断面关联。
66例患者（术后18±3个月）和41名未受伤个体参与研究。使用等长膝关节伸展任务评估股四头肌力量控制。参与者以缓慢速度在最大自主等长收缩的5%至30%之间循环增加和减少股四头肌力量，以匹配屏幕上显示的移动目标。同时使用表面肌电图评估股四头肌激活和腘绳肌协同激活。使用辛辛那提膝关节评分量表和三项单腿跳测试评估膝关节功能。
重建组完成任务时的均方根误差（RMSE）高48%，表明股四头肌力量控制明显更差（p<0.001）。在根据性别调整的多变量模型中，更高的RMSE和更大的外侧腘绳肌协同激活与更差的膝关节功能显著相关，即在一项或多项膝关节功能评估中得分<85%的可能性更大。
股四头肌力量输出准确性较低和腘绳肌协同激活增加与前交叉韧带重建术后膝关节功能较差有关，可能导致膝关节负荷不规则以及膝关节骨关节炎的发生或进展。股四头肌力量控制受损和肌肉激活策略改变可能通过神经肌肉训练得到改善，这是未来研究的一个领域。
病例对照研究，III级。
