Mostaed Maria F, Werner David M, Barrios Joaquin A
Department of Health of Sport Science, University of Dayton, Dayton, OH, USA.
Department of Physical Therapy, University of Dayton, Dayton, OH, USA.
Int J Sports Phys Ther. 2018 Feb;13(1):77-85.
The lateral step-down test is an established clinical evaluation tool to assess quality of movement in patients with knee disorders. However, this test has not been investigated in individuals after anterior cruciate ligament reconstruction (ACLR) in association with quantitative 3D motion analysis.
The purpose of this study was to determine the strength of association between visually-assessed quality of movement during the lateral step-down test and 3D lower limb kinematics in patients with history of ACLR. A second purpose was to compare kinematics between subgroups based on the presence or absence of faulty alignments during the task. The final purpose was to compare visually-assessed quality of movement scores between box heights during lateral step-down testing.
Twenty subjects at least one year status post-ACLR (18 females, age of 24.5 ± 4.6 years and body mass index of 23.4 ± 2.3 kg/m) performed the lateral step-down test unilaterally on the surgical limb atop four and six inch boxes. A board-certified orthopedic physical therapist scored overall quality of movement during the lateral step-down test using established criteria during 2D video playback. Lower limb kinematics were simultaneously collected using 3D motion capture. An alpha level of 0.05 was used for all statistical treatments.
Overall 2D quality of movement score significantly correlated (r =0.47-0.57) with 3D hip adduction and hip internal rotation across box heights. Across box heights, the presence of faulty pelvic alignment differentiated a subgroup exhibiting less peak knee flexion, and the presence of faulty knee alignment differentiated a subgroup exhibiting greater peak hip adduction. The six inch box elicited worse quality of movement compared to the four inch box.
These results suggest that visually-assessed quality of movement is associated with several kinematic variables after ACLR. 2D movement deviations at the pelvis appear to consistently relate to less knee flexion, and 2D deviations at the knee appear to suggest greater hip adduction. Generally, poorer quality of movement was observed for the six inch box height. Clinically, these data suggest that interventions targeting hip abductor and knee extensor strength and neuromuscular control may be useful in the presence of poor quality of movement during lateral step-down testing.
2b.
侧向下台阶试验是一种既定的临床评估工具，用于评估膝关节疾病患者的运动质量。然而，该试验尚未在接受前交叉韧带重建（ACLR）的个体中结合定量三维运动分析进行研究。
本研究的目的是确定ACLR病史患者在侧向下台阶试验中视觉评估的运动质量与三维下肢运动学之间的关联强度。第二个目的是根据任务期间是否存在错误对线情况，比较亚组之间的运动学差异。最后一个目的是比较侧向下台阶试验中不同箱高时视觉评估的运动质量得分。
20名ACLR术后至少一年的受试者（18名女性，年龄24.5±4.6岁，体重指数23.4±2.3kg/m²）在手术侧肢体单腿在4英寸和6英寸高的箱子上进行侧向下台阶试验。一名获得委员会认证的骨科物理治疗师在二维视频回放期间使用既定标准对侧向下台阶试验期间的整体运动质量进行评分。使用三维运动捕捉同时收集下肢运动学数据。所有统计处理的α水平均设定为0.05。
总体二维运动质量得分与不同箱高时的三维髋关节内收和髋关节内旋显著相关（r = 0.47 - 0.57）。在不同箱高时，骨盆对线错误的存在区分出一个膝关节屈曲峰值较小的亚组，而膝关节对线错误的存在区分出一个髋关节内收峰值较大的亚组。与4英寸的箱子相比，6英寸的箱子引发的运动质量更差。
这些结果表明，ACLR后视觉评估的运动质量与多个运动学变量相关。骨盆处的二维运动偏差似乎始终与较少的膝关节屈曲相关，而膝关节处的二维偏差似乎表明更大的髋关节内收。一般来说，6英寸箱高时观察到的运动质量较差。临床上，这些数据表明，针对髋关节外展肌和膝关节伸肌力量以及神经肌肉控制的干预措施，在侧向下台阶试验中运动质量较差的情况下可能会有用。
2b。
