髋关节外旋力量可预测前交叉韧带重建后单足跳跃表现。
Hip external rotation strength predicts hop performance after anterior cruciate ligament reconstruction.
机构信息
Department of Rehabilitation Sciences, University of Kentucky, Lexington, KY, 40536-0200, USA.
Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15203, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 Apr;26(4):1137-1144. doi: 10.1007/s00167-017-4534-6. Epub 2017 Apr 4.
PURPOSE
Quadriceps strength and single-leg hop performance are commonly evaluated prior to return to sport after anterior cruciate ligament reconstruction (ACLR). However, few studies have documented potential hip strength deficits after ACLR, or ascertained the relative contribution of quadriceps and hip strength to hop performance.
METHODS
Patients cleared for return to sports drills after ACLR were compared to a control group. Participants' peak isometric knee extension, hip abduction, hip extension, and hip external rotation (HER) strength were measured. Participants also performed single-leg hops, timed hops, triple hops, and crossover hops. Between-limb comparisons for the ACLR to control limb and the non-operative limb were made using independent two-sample and paired sample t tests. Pearson's correlations and stepwise multiple linear regression were used to determine the relationships and predictive ability of limb strength, graft type, sex, and limb dominance to hop performance.
RESULTS
Sixty-five subjects, 20 ACLR [11F, age 22.8 (15-45) years, 8.3 ± 2 months post-op, mass 70.47 ± 12.95 kg, height 1.71 ± 0.08 m, Tegner 5.5 (3-9)] and 45 controls [22F, age 25.8 (15-45) years, mass 74.0 ± 15.2 kg, height 1.74 ± 0.1 m, Tegner 6 (3-7)], were tested. Knee extension (4.4 ± 1.5 vs 5.4 ± 1.8 N/kg, p = 0.02), HER (1.4 ± 0.4 vs 1.7 ± 0.5 N/kg, p = 0.04), single-leg hop (146 ± 37 vs 182 ± 38% limb length, p < 0.01), triple hop (417 ± 106 vs 519 ± 102% limb length, p < 0.01), timed hop (3.3 ± 2.0 vs 2.3 ± 0.6 s, p < 0.01), and crossover hop (364 ± 107 vs 446 ± 123% limb length, p = 0.01) were significantly impaired in the operative versus control subject limbs. Similar deficits existed between the operative and non-operative limbs. Knee extension and HER strength were significantly correlated with each of the hop tests, but only HER significantly predicted hop performance.
CONCLUSIONS
After ACLR, patients have persistent HER strength, knee extension strength, and hop test deficits in the operative limb compared to the control and non-operative limbs, even after starting sport-specific drills. Importantly, HER strength independently predicted hop performance. Based on these findings, to resolve between-limb deficits in strength and hop performance clinicians should include HER strengthening exercises in post-operative rehabilitation.
LEVEL OF EVIDENCE
Prognostic Study, Level II.
目的
在 ACLR 后重返运动之前，通常会评估股四头肌力量和单腿跳跃表现。然而，很少有研究记录 ACLR 后的潜在臀部力量缺陷，或者确定股四头肌和臀部力量对跳跃表现的相对贡献。
方法
比较 ACLR 后获准重返运动训练的患者和对照组。测量参与者的等长膝关节伸展、髋关节外展、髋关节伸展和髋关节外旋（HER）的最大力量。参与者还进行了单腿跳跃、计时跳跃、三连跳和交叉跳跃。使用独立两样本和配对样本 t 检验对 ACLR 到对照肢体和非手术肢体进行肢体间比较。使用 Pearson 相关系数和逐步多元线性回归来确定肢体力量、移植物类型、性别和肢体优势与跳跃表现的关系和预测能力。
结果
65 名受试者，20 名 ACLR [11F，年龄 22.8（15-45）岁，术后 8.3±2 个月，体重 70.47±12.95kg，身高 1.71±0.08m，Tegner 5.5（3-9）]和 45 名对照组 [22F，年龄 25.8（15-45）岁，体重 74.0±15.2kg，身高 1.74±0.1m，Tegner 6（3-7）]接受了测试。膝关节伸展（4.4±1.5 与 5.4±1.8 N/kg，p=0.02），HER（1.4±0.4 与 1.7±0.5 N/kg，p=0.04），单腿跳跃（146±37 与 182±38%肢体长度，p<0.01），三连跳（417±106 与 519±102%肢体长度，p<0.01），计时跳跃（3.3±2.0 与 2.3±0.6 s，p<0.01）和交叉跳跃（364±107 与 446±123%肢体长度，p=0.01）在手术肢体与对照组之间显著受损。手术肢体和非手术肢体之间也存在类似的缺陷。膝关节伸展和 HER 力量与每项跳跃测试均显著相关，但只有 HER 显著预测跳跃表现。
结论
在 ACLR 后，与对照和非手术肢体相比，患者在手术肢体中仍存在持续的 HER 力量、膝关节伸展力量和跳跃测试缺陷，即使在开始特定运动的训练后也是如此。重要的是，HER 力量独立预测跳跃表现。基于这些发现，为了解决肢体间力量和跳跃表现的缺陷，临床医生应在术后康复中包括 HER 强化练习。
证据水平
预后研究，II 级。
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