Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland.
Department for Health, University of Bath, Bath, UK.
Scand J Med Sci Sports. 2019 Aug;29(8):1212-1222. doi: 10.1111/sms.13441. Epub 2019 May 27.
After anterior cruciate ligament reconstruction (ACLR), there is a higher re-injury rate to the contralateral limb in athletes who undergo surgery using a bone-patellar-tendon-bone (BPTB) autograft than using a semitendinosus and gracilis hamstring tendon (HT) autograft. This may be influenced by differing lower-limb loading asymmetries present when athletes of each graft type return to play (RTP). The aim of this study was to compare bilateral countermovement jump (CMJ) phase-specific impulse asymmetries between athletes with BPTB and HT autografts 9 months post-ACLR, and to identify the relationship between impulse and isokinetic strength asymmetries. Male field sport athletes with a BPTB (n = 22) or HT (n = 22) autograft were tested approximately 9 months post-ACLR. An uninjured control group (n = 22) was also tested on a single occasion. Phase-specific bilateral absolute impulse asymmetries were calculated during the CMJ and compared between groups using Kruskal-Wallis and post-hoc testing. A linear regression model was used to assess the relationship between impulse asymmetries and isokinetic concentric knee extensor strength asymmetries. BPTB athletes demonstrated greater impulse asymmetries than HT athletes during the eccentric (P = 0.01) and concentric (P = 0.008) phases of the jump. Isokinetic strength asymmetry was a significant predictor of CMJ concentric impulse asymmetry in both BPTB (r = 0.39) and HT athletes (r = 0.18) but not eccentric impulse asymmetry in any group. The greater loading asymmetries demonstrated by BPTB than HT athletes 9 months after ACLR may contribute to the differing incidence rates of contralateral ACL injury. The findings suggest that graft-specific loading asymmetries should be targeted during rehabilitation prior to RTP.
在前交叉韧带重建（ACLR）后，接受骨髌腱骨（BPTB）自体移植物手术的运动员在重返运动（RTP）时，其对侧肢体的再损伤率高于接受半腱肌和股薄肌肌腱（HT）自体移植物手术的运动员。这可能受到两种移植物类型的运动员在重返运动时下肢负荷不对称的影响。本研究的目的是比较 ACLR 后 9 个月时接受 BPTB 和 HT 自体移植物的运动员双侧反向跳跃（CMJ）相特定冲量的不对称性，并确定冲量和等速力量不对称性之间的关系。接受 BPTB（n=22）或 HT（n=22）自体移植物的男性运动项目运动员在 ACLR 后大约 9 个月时接受了测试。一个未受伤的对照组（n=22）也在一次测试中接受了测试。在 CMJ 期间计算了相特定的双侧绝对冲量不对称性，并使用 Kruskal-Wallis 和事后检验比较了组间差异。线性回归模型用于评估冲量不对称性与等速向心膝关节伸肌力量不对称性之间的关系。BPTB 运动员在跳跃的离心（P=0.01）和向心（P=0.008）阶段的冲量不对称性大于 HT 运动员。在 BPTB（r=0.39）和 HT 运动员（r=0.18）中，等速力量不对称性是 CMJ 向心冲量不对称性的一个显著预测因子，但在任何组的偏心冲量不对称性中都不是。ACL 重建后 9 个月，BPTB 运动员比 HT 运动员表现出更大的负荷不对称性，这可能导致对侧 ACL 损伤发生率的不同。研究结果表明，在 RTP 之前的康复过程中，应针对特定移植物的负荷不对称性进行治疗。
