Fältström Anne, Hägglund Martin, Kvist Joanna
Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Am J Sports Med. 2017 Feb;45(2):377-385. doi: 10.1177/0363546516667266. Epub 2016 Oct 7.
Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR).
This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)-reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams.
Cross-sectional study; Level of evidence, 3.
This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses.
The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players' matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended guidelines for all 5 tests ( P = .837).
The reconstructed and uninvolved limbs did not differ, and players with an ACL-reconstructed knee and controls differed only minimally on the functional performance tests, indicating similar function. It is worth noting that many players with an ACL-reconstructed knee and controls had movement asymmetries and a high pKAM pattern, which have previously been associated with an increased risk for both primary and secondary ACL injury in female athletes.
良好的功能表现及肢体对称性被认为对于在重建前交叉韧带（ACLR）后恢复旋转和接触性运动时将受伤风险降至最低至关重要。
本研究旨在调查单侧前交叉韧带（ACL）重建的女性足球运动员在功能表现和运动不对称方面的任何左右肢体差异，并将这些运动员与来自同一足球队的膝关节健康的对照组进行比较。
横断面研究；证据等级，3级。
本研究纳入了77名活跃的女性足球运动员，她们在ACLR后中位时间为18个月（四分位间距[IQR]，14.5个月；范围，7 - 39个月），以及77名膝关节健康的女性足球运动员。ACL重建膝关节的运动员平均年龄为20.1±2.3岁，对照组为19.5±2.2岁。我们使用了一系列测试来评估姿势控制（星标偏移平衡测试）和单腿跳性能（单腿跳远距离、5跳测试和侧向跳）。使用二维分析通过下落垂直跳和收腹跳评估下肢和躯干的运动不对称性。
在任何测试中，重建肢体和未受累肢体均无差异。在5跳测试中，ACL重建膝关节的运动员表现比对照组差（平均8.75±1.05米对9.09±0.89米；P = 0.034）。在下落垂直跳测试中，与对照组运动员匹配的肢体（按腿的优势）相比，ACL重建的肢体在额状面的膝外翻运动明显更少（中位数0.028米[IQR，0.049米]对0.045米[IQR，0.043米]；P = 0.004），并且高膝外展力矩（pKAM）的概率更低（中位数69.2%[IQR，44.4%]对79.8%[IQR，44.8%]；P = 0.043）。结果显示，两组中9%至49%的运动员在不同测试中的表现超出了推荐指南。只有14名ACL重建膝关节的运动员（18%）和15名对照组运动员（19%）的结果符合所有5项测试的推荐指南（P = 0.837）。
重建肢体和未受累肢体无差异，ACL重建膝关节的运动员和对照组在功能表现测试中仅存在极小差异，表明功能相似。值得注意的是，许多ACL重建膝关节的运动员和对照组运动员存在运动不对称和高pKAM模式，这与女性运动员原发性和继发性ACL损伤风险增加有关。
