Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, VIC, 3010, Australia.
Department of Physiotherapy, Monash University, Frankston, VIC, Australia.
Gait Posture. 2020 Mar;77:283-287. doi: 10.1016/j.gaitpost.2020.02.011. Epub 2020 Feb 18.
Dynamic postural control during everyday tasks is poorly understood in people following anterior cruciate ligament reconstruction (ACLR). Understanding dynamic postural control can provide insight into potentially modifiable impairments in people following ACLR who are at increased risk for second ACL injury and/or knee osteoarthritis.
Determine whether measures indicative of dynamic postural control differ between individuals with and without ACLR during stair ascent and descent.
Seventeen individuals with ACLR (>1 yr post-surgery) and 16 age and sex-matched healthy controls participated. Centre of pressure (COP) measures included: i) COP excursion, ii) COP velocity, and iii) dynamic time-toboundary (TTB). Mixed linear models were used to compare COP measures for the ACLR leg, non-ACLR leg, and healthy controls during stair ascent and stair descent.
There were no statistically significant differences observed during stair ascent (all p > 0.05). Several statistical differences were found during stair descent for individual with ACLR, but not between those with ACLR and healthy controls. The ACLR leg had higher medial-lateral COP excursion (mean difference 1.06 cm, [95 %CI 0.08-2.06 cm], p = 0.036; effect size = 0.38) compared to the non-ACLR leg during stair descent. In addition, the ACLR leg had a lower medial-lateral TTB (mean difference -13 ms [95 %CI -38 to 2 ms], p = 0.005; effect size = 0.49) and medial-lateral TTB normalized to stance time (mean difference -5.8 % [95 %CI -10.3 to 1.3 %], p = 0.012; effect size = 0.80) compared to the non-ACLR leg during stair descent. No statistical differences were observed for anterior-posterior measures during stair descent (all p > 0.05).
Taken together, findings indicate that there are small to large differences in medial-lateral postural control in the ACLR leg compared to the non-ACLR leg during stair descent. Further work is required to understand clinical implication of these novel observations.
在前交叉韧带重建（ACL）术后，人们对日常任务中的动态姿势控制知之甚少。了解动态姿势控制可以深入了解 ACL 重建后可能存在的可改变的功能障碍，这些功能障碍会增加人们再次 ACL 损伤和/或膝关节骨关节炎的风险。
确定在上下楼梯时，ACL 重建后（术后>1 年）的个体与无 ACL 重建的个体之间是否存在与动态姿势控制相关的指标差异。
17 名 ACL 重建患者（术后>1 年）和 16 名年龄和性别匹配的健康对照者参与了本研究。包括以下压力中心（COP）指标：i）COP 偏移量，ii）COP 速度，和 iii）动态边界到达时间（TTB）。使用混合线性模型比较了 ACL 重建侧、非 ACL 重建侧和健康对照组在上下楼梯时的 COP 指标。
在上下楼梯时，没有观察到统计学上的显著差异（所有 p > 0.05）。在 ACL 重建患者中，在上下楼梯时，有几个指标存在统计学差异，但在 ACL 重建患者与健康对照组之间没有差异。与非 ACL 重建侧相比，ACL 重建侧在上下楼梯时的横向 COP 偏移量更高（平均差异 1.06cm，[95%CI 0.08-2.06cm]，p=0.036；效应量=0.38）。此外，ACL 重建侧的横向 TTB 更小（平均差异-13ms[95%CI-38 至 2ms]，p=0.005；效应量=0.49）和横向 TTB 与站立时间的归一化值更小（平均差异-5.8%[95%CI-10.3 至 1.3%]，p=0.012；效应量=0.80）与非 ACL 重建侧相比。在上下楼梯时，前后向测量无统计学差异（所有 p > 0.05）。
总的来说，这些发现表明，在上下楼梯时，ACL 重建侧与非 ACL 重建侧相比，横向姿势控制存在小到中等程度的差异。需要进一步的工作来了解这些新发现的临床意义。
