Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware.
Department of Physical Therapy, University of Delaware, Newark, Delaware.
J Orthop Res. 2019 Aug;37(8):1743-1753. doi: 10.1002/jor.24314. Epub 2019 May 20.
Women after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) are more likely than men to exhibit asymmetric movement patterns, which are associated with post-traumatic osteoarthritis. We developed the ACL specialized post-operative return-to-sports (ACL-SPORTS) randomized control trial to test the effect of strength, agility, plyometric, and secondary prevention (SAPP) training with and without perturbation training (SAPP + PERT) on gait mechanics in women after ACLR. We hypothesized that movement symmetry would improve over time across both groups but more so among the SAPP + PERT group. Thirty-nine female athletes 3-9 months after primary ACLR were randomized to SAPP or SAPP + PERT training. Biomechanical testing during overground walking occurred before (Pre-training) and after (Post-training) training and one and 2 years post-operatively. Hip and knee kinematic and kinetic variables were compared using repeated measures analysis of variance with Bonferroni corrections for post hoc comparisons (α = 0.05). There was a time by limb interaction effect (p = 0.028) for peak knee flexion angle (PKFA), the primary outcome which powered the study, characterized by smaller PKFA in the involved compared to uninvolved limbs across treatment groups at Pre-training, Post-training, and 1 year, but not 2 years. Similar findings occurred across sagittal plane knee excursions and kinetics and hip extension excursion at midstance. There were no meaningful interactions involving group. Neither SAPP nor SAPP + PERT training improved walking mechanics, which persisted 1 but not 2 years after ACLR. Statement of clinical significance: Asymmetrical movement patterns persisted long after participants achieved symmetrical strength and functional performance, suggesting more time is needed to recover fully after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1743-1753, 2019.
女性在前交叉韧带（ACL）损伤和 ACL 重建（ACLR）后比男性更有可能表现出不对称的运动模式，这与创伤后骨关节炎有关。我们开发了 ACL 专门的术后重返运动（ACL-SPORTS）随机对照试验，以测试力量、敏捷性、增强式训练和二次预防（SAPP）训练以及有无扰动训练（SAPP+PERT）对 ACLR 后女性步态力学的影响。我们假设两组的运动对称性都会随着时间的推移而改善，但 SAPP+PERT 组的改善更为明显。39 名女性运动员在 ACLR 后 3-9 个月随机分为 SAPP 或 SAPP+PERT 训练组。在训练前（Pre-training）和训练后（Post-training）以及术后 1 年和 2 年进行了地面行走的生物力学测试。使用重复测量方差分析比较髋关节和膝关节运动学和动力学变量，并进行事后比较的 Bonferroni 校正（α=0.05）。主要结局指标峰值膝关节屈曲角度（PKFA）的时间与肢体交互效应（p=0.028），其特征是治疗组在 Pre-training、Post-training 和 1 年时，患侧的 PKFA 小于健侧，但在 2 年时则没有。在矢状面膝关节运动和动力学以及中足时的髋关节伸展运动中也出现了类似的发现。没有涉及组的有意义的相互作用。SAPP 或 SAPP+PERT 训练都没有改善步行力学，这种情况在 ACLR 后 1 年但不是 2 年仍然存在。临床意义声明：参与者在获得对称的力量和功能表现后很长时间仍然存在不对称的运动模式，这表明 ACLR 后需要更多的时间才能完全恢复。2019 年骨科研究协会。由 Wiley Periodicals，Inc. 出版。J Orthop Res 37:1743-1753，2019。
