J Orthop Sports Phys Ther. 2018 Mar;48(3):162-173. doi: 10.2519/jospt.2018.7459. Epub 2018 Jan 6.
Study Design Controlled laboratory study. Background The inclusion of specific exercises in rehabilitation after knee injury is currently expert based, as a thorough description of the knee contact forces during different exercises is lacking. Objective To quantify knee loading during frequently used activities such as squats, lunges, single-leg hops, walking stairs, standing up, and gait, and to grade knee joint loading during these activities. Methods Three-dimensional motion-analysis data of 15 healthy adults were acquired during 9 standardized activities used in rehabilitation. Experimental motion data were processed using musculoskeletal modeling to calculate contact and shear forces on the different knee compartments (tibiofemoral and patellofemoral). Using repeated-measures analyses of variance, contact and shear forces were compared between compartments and exercises, whereas muscle and average maximum femoral forces were compared only between exercises. Results With the exception of squats, all therapeutic exercises imposed higher forces to the tibiofemoral joint compared to gait. Likewise, patellofemoral forces were greater during all exercises when compared to gait. Greater compartmental contact forces were accompanied by greater compartmental shear forces. Furthermore, force distribution over the medial and lateral compartments varied between exercises. With increased knee flexion, more force was imposed on the posterior portion of the condyles. Conclusion These results suggest that with careful selection of exercises, forces on an injured zone of the joint can be reduced, as the force distribution differs strongly between exercises. Based on the results, a graded exercise program for progressive knee joint loading during rehabilitation can be conceptualized. J Orthop Sports Phys Ther 2018;48(3):162-173. Epub 6 Jan 2018. doi:10.2519/jospt.2018.7459.
对照实验室研究。背景：目前，膝关节损伤后康复中包含特定运动的依据是专家意见，因为缺乏对不同运动中膝关节接触力的详细描述。目的：量化深蹲、弓步、单腿跳、上下楼梯、站立和行走等常用活动中的膝关节负荷，并对这些活动中的膝关节关节负荷进行分级。方法：对 15 名健康成年人在 9 种康复中常用的标准化活动中进行了三维运动分析数据采集。使用肌肉骨骼建模对实验运动数据进行处理，以计算不同膝关节腔（胫股和髌股）的接触力和剪切力。使用重复测量方差分析比较各关节腔和各运动之间的接触力和剪切力，而肌肉和平均最大股骨力仅在运动之间进行比较。结果：除了深蹲之外，所有治疗性运动对胫股关节的施加的力都高于行走。同样，与行走相比，所有运动都会对髌股关节产生更大的力。关节腔的接触力越大，关节腔的剪切力也越大。此外，各运动之间的力分布也有所不同。随着膝关节弯曲度的增加，更多的力施加在髁的后部分。结论：这些结果表明，通过仔细选择运动，可以减少受伤关节区域的受力，因为各运动之间的力分布差异很大。根据这些结果，可以为康复期间膝关节渐进性加载设计分级运动方案。《美国骨科运动物理治疗杂志》2018 年；48（3）：162-173。2018 年 1 月 6 日在线发表。doi:10.2519/jospt.2018.7459.
