Kollock Roger O, Andrews Corey, Johnston Ashlyn, Elliott Teresa, Wilson Alan E, Games Kenneth E, Sefton JoEllen M
Department of Kinesiology and Rehabilitative Sciences, University of Tulsa, OK.
Athletic Training Post-Certification Graduate Program, Auburn University, AL.
J Athl Train. 2016 Nov;51(11):919-926. doi: 10.4085/1062-6050-51.4.09. Epub 2016 Mar 31.
Knee overuse injuries are the most common musculoskeletal complaints in military trainees and are common in active-duty warfighters. Muscle strengthening is usually recommended; however, research is conflicting in this area, which makes it difficult to develop effective screening, prevention, and training interventions for warfighters.
To determine if lower extremity muscular weakness contributes to knee overuse injuries and identify specific muscular involvement.
We searched MEDLINE, PubMed, Web of Science, SPORTDiscus, CINAHL, and Military & Government Collection and reference lists of relevant articles published between January 1, 2000, and January 1, 2013.
For inclusion, requirements were uninjured and injured groups; provision of the sample size, means, and standard deviations for all groups; identification of the specific muscles assessed; and clearly defined knee injury.
Sample size, sex, and muscle strength means and standard deviations.
Twenty-five studies met these criteria. We used the Scottish Intercollegiate Guidelines Network algorithm to determine the appropriate tool for appraising article quality. Unweighted random-effects model meta-analyses were conducted. Separate meta-analyses were performed for the moderators of strength measurement scale (absolute or normalized muscle strength), muscle group, and sex. A weighted random-effects model with a Hedges g effect metric and 95% confidence intervals were used for comparison across studies.
Our meta-analysis suggests that individuals with symptoms of a knee overuse injury have lower absolute and normalized hip muscle strength. Specifically, they had lower absolute hip external-rotator, knee-extensor, and knee-flexor strength, as well as lower normalized hip external-rotator, hip-extensor, and hip-abductor strength, compared with asymptomatic control participants. The findings suggest a possible link between lower hip and thigh strength and knee overuse injuries. Further research is needed to determine if weakness is a cause or a result of knee overuse injuries before screening and intervention can be developed for at-risk warfighters.
膝关节过度使用损伤是军事训练人员中最常见的肌肉骨骼问题，在职作战人员中也很常见。通常建议进行肌肉强化训练；然而，该领域的研究结果相互矛盾，这使得难以针对作战人员制定有效的筛查、预防和训练干预措施。
确定下肢肌肉无力是否会导致膝关节过度使用损伤，并确定具体受累肌肉。
我们检索了MEDLINE、PubMed、科学网、体育医学数据库、护理学与健康领域数据库以及军事与政府文献数据库，并查阅了2000年1月1日至2013年1月1日期间发表的相关文章的参考文献列表。
纳入标准为未受伤组和受伤组；提供所有组的样本量、均值和标准差；确定所评估的具体肌肉；以及明确界定的膝关节损伤。
样本量、性别以及肌肉力量均值和标准差。
25项研究符合这些标准。我们使用苏格兰校际指南网络算法来确定评估文章质量的合适工具。进行了非加权随机效应模型荟萃分析。针对力量测量量表（绝对或标准化肌肉力量）、肌肉群和性别的调节因素进行了单独的荟萃分析。采用具有Hedges g效应量度和95%置信区间的加权随机效应模型进行跨研究比较。
我们的荟萃分析表明，有膝关节过度使用损伤症状的个体，其绝对和标准化的髋部肌肉力量较低。具体而言，与无症状对照参与者相比，他们的绝对髋部外旋肌、膝关节伸肌和膝关节屈肌力量较低，标准化的髋部外旋肌、髋部伸肌和髋部外展肌力量也较低。研究结果表明，髋部和大腿力量较低与膝关节过度使用损伤之间可能存在联系。在为有风险的作战人员制定筛查和干预措施之前，需要进一步研究以确定无力是膝关节过度使用损伤的原因还是结果。
