Slater Lindsay V, Hart Joseph M, Kelly Adam R, Kuenze Christopher M
Department of Kinesiology, The University of Virginia, Charlottesville.
Department of Kinesiology, Michigan State University, East Lansing.
J Athl Train. 2017 Sep;52(9):847-860. doi: 10.4085/1062-6050-52.6.06.
Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) result in persistent alterations in lower extremity movement patterns. The progression of lower extremity biomechanics from the time of injury has not been described.
To compare the 3-dimensional (3D) lower extremity kinematics and kinetics of walking among individuals with ACL deficiency (ACLD), individuals with ACLR, and healthy control participants from 3 to 64 months after ACLR.
We searched PubMed and Web of Science from 1970 through 2013.
We selected only articles that provided peak kinematic and kinetic values during walking in individuals with ACLD or ACLR and comparison with a healthy control group or the contralateral uninjured limb.
A total of 27 of 511 identified studies were included. Weighted means, pooled standard deviations, and 95% confidence intervals were calculated for the healthy control, ACLD, and ACLR groups at each reported time since surgery. The magnitude of between-groups (ACLR versus ACLD, control, or contralateral limb) differences at each time point was evaluated using Cohen d effect sizes and associated 95% confidence intervals. Peak knee-flexion angle (Cohen d = -0.41) and external knee-extensor moment (Cohen d = -0.68) were smaller in the ACLD than in the healthy control group. Peak knee-flexion angle (Cohen d range = -0.78 to -1.23) and external knee-extensor moment (Cohen d range = -1.39 to -2.16) were smaller in the ACLR group from 10 to 40 months after ACLR. Reductions in external knee-adduction moment (Cohen d range = -0.50 to -1.23) were present from 9 to 42 months after ACLR.
Reductions in peak knee-flexion angle, external knee-flexion moment, and external knee-adduction moment were present in the ACLD and ACLR groups. This movement profile during the loading phase of gait has been linked to knee-cartilage degeneration and may contribute to the development of osteoarthritis after ACLR.
前交叉韧带（ACL）损伤和ACL重建（ACLR）会导致下肢运动模式持续改变。但自损伤发生后下肢生物力学的进展情况尚未得到描述。
比较ACL缺失（ACLD）患者、ACLR患者以及健康对照者在ACLR后3至64个月的三维（3D）下肢步行运动学和动力学情况。
我们检索了1970年至2013年期间的PubMed和科学网。
我们仅选取了那些提供了ACLD或ACLR患者步行过程中的运动学和动力学峰值数据，并与健康对照组或对侧未受伤肢体进行比较的文章。
在511项已识别的研究中，共纳入了27项。计算了自手术以来各报告时间点健康对照组、ACLD组和ACLR组的加权均值、合并标准差和95%置信区间。使用Cohen d效应量及相关的95%置信区间评估各时间点组间（ACLR与ACLD、对照组或对侧肢体）差异的大小。ACLD组的峰值屈膝角度（Cohen d = -0.41）和膝关节外侧伸肌力矩（Cohen d = -0.68）小于健康对照组。ACLR后10至40个月，ACLR组的峰值屈膝角度（Cohen d范围 = -0.78至-1.23）和膝关节外侧伸肌力矩（Cohen d范围 = -1.39至-2.16）较小。ACLR后9至42个月，膝关节内收力矩减小（Cohen d范围 = -0.50至-1.23）。
ACLD组和ACLR组均出现了峰值屈膝角度、膝关节外侧屈肌力矩和膝关节内收力矩减小的情况。步态负重期的这种运动特征与膝关节软骨退变有关，可能会导致ACLR后骨关节炎的发生。
