School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.
Sports Med. 2018 Sep;48(9):2103-2126. doi: 10.1007/s40279-018-0942-0.
Anterior cruciate ligament reconstruction (ACLR) may not restore lower limb biomechanics during single-limb landings.
Our objective was to identify and evaluate differences in lower limb biomechanics during high-demand single-limb landings between the ACLR limb and the contralateral limb and healthy control participants.
A systematic review of the literature was conducted using six electronic databases searched until April 2017 for published peer-reviewed studies that investigated lower limb biomechanics on the ACLR limb compared with either the contralateral limb or those of control participants. Meta-analysis with standardized mean differences (SMD) were performed for peak angles and moments (hip, knee and ankle joints) in the sagittal plane during single-limb landing tasks.
A total of 35 studies met inclusion criteria. Four different single-leg landing tasks were identified: forward hop (n = 24 studies), landing from a height (n = 9 studies), vertical hop (n = 4 studies), and diagonal leap (n = 1 study). A reduced peak knee flexion angle was found in the ACLR limb compared with the contralateral limb during a forward hop landing task (SMD - 0.39; 95% confidence interval [CI] - 0.59 to - 0.18) and compared with a control group (SMD between - 1.01 and - 0.45) for all three reported single-leg landing tasks: forward hop, landing from a height, and diagonal leap. Similarly, a reduced peak knee internal extensor moment was found in the ACLR limb compared with the contralateral limb for all three reported landing tasks: forward hop, landing from a height, vertical hop (SMD between - 1.43 and - 0.53), and in two of three landing tasks when compared with a control group (SMD between - 1.2 and - 0.52). No significant differences in peak flexion (hip and ankle) angle or peak (hip and ankle) internal extensor moment were found in the ACLR limb compared with both the contralateral limb and a control group.
Participants performed single-limb landings on the ACLR limb with reductions in peak sagittal knee kinematics as well as peak joint moments compared with both the contralateral limb and a control group. Stiffer single-leg landings potentially expose the knee joint to higher forces, which may increase risk of injury. Clinical testing after ACLR surgery should explore movement quality as well as performance of functional tasks.
Case-control, IV.
前交叉韧带重建（ACLR）可能无法在单腿着陆时恢复下肢生物力学。
我们的目的是确定并评估 ACLR 肢体与对侧肢体以及健康对照组在高需求单腿着陆期间下肢生物力学的差异。
系统检索了六个电子数据库，直到 2017 年 4 月，对已发表的同行评审研究进行了文献综述，这些研究调查了 ACLR 肢体与对侧肢体或对照组参与者在单腿着陆任务中的下肢生物力学。采用标准化均数差值（SMD）对矢状面中单腿着陆任务时的峰值角度和峰值力矩（髋关节、膝关节和踝关节）进行荟萃分析。
共有 35 项研究符合纳入标准。确定了四种不同的单腿着陆任务：前向跳跃（n=24 项研究）、从高处降落（n=9 项研究）、垂直跳跃（n=4 项研究）和对角跳跃（n=1 项研究）。在向前跳跃着陆任务中，与对侧肢体相比，ACLR 肢体的膝关节屈曲角度峰值较低（SMD-0.39；95%置信区间[CI]-0.59 至-0.18），与对照组相比（SMD 为-1.01 至-0.45），所有三种报告的单腿着陆任务：前向跳跃、从高处降落和对角跳跃，均发现这种情况。同样，与对侧肢体相比，在所有三种报告的着陆任务中，ACLR 肢体的膝关节内收肌峰值力矩降低：前向跳跃、从高处降落、垂直跳跃（SMD 为-1.43 至-0.53），与对照组相比，在两种任务中（SMD 为-1.2 至-0.52）。与对侧肢体和对照组相比，ACLR 肢体的峰值（髋关节和踝关节）屈曲角度和峰值（髋关节和踝关节）内收肌力矩没有明显差异。
与对侧肢体和对照组相比，参与者在 ACLR 肢体上进行单腿着陆时，矢状面膝关节运动学峰值和关节力矩峰值均降低。更僵硬的单腿着陆可能使膝关节承受更高的力，从而增加受伤的风险。ACL 重建手术后的临床检查应探索运动质量以及功能性任务的表现。
病例对照，IV 级。
