在 ACL 重建后获得运动许可时，拖拽雪橇和穿负重背心的生物力学特征。
Biomechanical Profiles When Towing a Sled and Wearing a Weighted Vest Once Cleared for Sports Post-ACL Reconstruction.
机构信息
Department of Physical Therapy, University of New England, Portland, Maine
Department of Physical Therapy, University of New England, Portland, Maine.
出版信息
Sports Health. 2016 Sep;8(5):456-64. doi: 10.1177/1941738116659855. Epub 2016 Aug 1.
BACKGROUND
Though rehabilitation attempts to correct "stiff knee gait" and control for dynamic limb valgus after anterior cruciate ligament reconstruction (ACLR), impaired biomechanics often persist when an individual is cleared to return to sport (RTS). Reduced knee extension moments (KEMs) and knee flexion angles (KFAs) often continue. While at the hip, increased hip adduction angles (HADDAs) and hip internal rotation angles (HIRAs) often persist in spite of dynamic hip stabilization exercises. Sled towing and weighted vest tasks increase KEM and hip extension moments (HEMs) in healthy individuals, yet biomechanical profiles during these tasks after ACLR are unknown.
HYPOTHESIS
Weighted gait will increase KEM, HEM, hip abduction moments (HABDMs), and hip external rotation moments (HERMs) and will not increase unwanted biomechanics (limb asymmetries, HIRA, HADDA) compared with normal gait.
STUDY DESIGN
Controlled laboratory study.
LEVEL OF EVIDENCE
Level 4.
METHODS
Fourteen men and 24 women who were 5 to 12 months after ACLR, had no concomitant ligament injuries, and were cleared to RTS were recruited. Sexes were evaluated independently given the sex-specific incidence to ACL injury, reinjury, and gait responses to certain interventions. Joint moment impulses and peak angles over the first 25% of stance were compared between limbs and across tasks (eg, unweighted gait, sled 50% body weight [BW], and vest 50% BW).
RESULTS
Men showed that weighted gait increased KEM, HEM, HERM, HADBM (vest only), HADDA, HIRA (sled only), and KFA. Asymmetrical KEM and KFA existed across tasks. Women showed that weighted gait increased KEM, HEM, HERM, HADBM (vest only), HFA (sled only), HADDA, and KFA. Asymmetrical KEM, HEM, HIRA, and KFA (sled only) existed across tasks.
CONCLUSION
Weighted gait generally increased joint moments. Unwanted biomechanics were unique for each weighted gait task.
CLINICAL RELEVANCE
Though joint moments increased, both tasks created unwanted biomechanics after ACLR. Persistent hip (women only) and KEM asymmetries across tasks when cleared to RTS are concerning given the relationship among these biomechanics and decreased functional performance.
背景
尽管康复尝试纠正“僵硬的膝关节步态”并控制前交叉韧带重建（ACL）后的动态肢体外翻，但当个体被允许重返运动（RTS）时，生物力学往往仍存在缺陷。膝关节伸展力矩（KEM）和膝关节屈曲角度（KFA）往往持续降低。而在髋关节，尽管进行了动态髋关节稳定练习，但髋关节内收角度（HADDAs）和髋关节内旋角度（HIRAs）仍持续增加。雪橇牵引和负重背心任务可增加健康个体的 KEM 和髋关节伸展力矩（HEMs），但 ACLR 后这些任务中的生物力学特征尚不清楚。
假设
与正常步态相比，负重步态会增加 KEM、HEM、髋关节外展力矩（HABDMs）和髋关节外旋力矩（HERMs），并且不会增加不必要的生物力学（肢体不对称、HIRA、HADDA）。
研究设计
对照实验室研究。
证据水平
4 级。
方法
招募了 14 名男性和 24 名女性，他们在 ACLR 后 5 至 12 个月，没有合并韧带损伤，并且已获准 RTS。考虑到 ACL 损伤、再损伤和某些干预措施对步态的反应的性别特异性发生率，分别对男性和女性进行了评估。比较了肢体间和任务间（例如，无负重步态、雪橇 50%体重 [BW] 和背心 50% BW）的关节力矩脉冲和前 25%支撑期的峰值角度。
结果
男性表现为负重步态增加了 KEM、HEM、HERM、HADBM（仅背心）、HADDA、HIRA（仅雪橇）和 KFA。在各个任务中，KEM 和 KFA 存在不对称性。女性表现为负重步态增加了 KEM、HEM、HERM、HADBM（仅背心）、HFA（仅雪橇）、HADDA 和 KFA。在各个任务中，KEM、HEM、HIRA 和 KFA（仅雪橇）存在不对称性。
结论
负重步态通常会增加关节力矩。每个负重步态任务都有不必要的生物力学。
临床相关性
尽管关节力矩增加，但 ACLR 后，这两个任务都产生了不必要的生物力学。当被允许重返运动时，在清除任务中髋关节（仅女性）和 KEM 不对称性持续存在，这与这些生物力学之间的关系以及功能表现下降有关。
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