Department of Orthopedics, General Hospital of PLA, Beijing, China.
Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China.
Orthop Surg. 2020 Apr;12(2):421-428. doi: 10.1111/os.12607. Epub 2020 Mar 8.
To investigate the biomechanical characteristics of patients with anterior cruciate ligament (ACL) injury by gait analysis, surface electromyography (SEMG), and proprioception test, and provide rehabilitation suggestions according to the results.
In this retrospective cohort study, 90 adults with unilateral ACL injury, ranging in age from 19 to 45 years (66 men and 24 women, average age: 30.03 ± 7.91) were recruited for this study form May 2018 to July 2019. They were divided into three groups according to the time after the injury: group A (3-week to 1.5-month), group B (1.5-month to 1 year), and group C (more than 1 year). The SEMG signals were collected from the bilateral rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) and the root mean square (RMS) were used to assess muscular activity. SEMG were used to analyze muscles function, gait analysis was used to evaluate the walking stability, balance and location assessment were used to analyze the proprioception.
Through the comparison between bilateral limbs, all muscles strength shown decreased (RF: 239.94 ± 129.70 vs 364.81 ± 148.98, P = 0.001; VM: 298.88 ± 175.41 vs 515.79 ± 272.49, P = 0.001; VL:389.54 ± 157.97 vs 594.28 ± 220.31, P < 0.001) and the division of proprioception became larger (tandem position: 7.79 ± 1.57 vs 6.33 ± 1.49, P = 0.001; stance with one foot: 8.13 ± 0.84 vs 7.1 ± 0.57, P = 0.003; variance of 30°: 6.96 ± 3.15 vs 4.45 ± 1.67, P = 0.03; variance of 60°: 4.64 ± 3.38 vs 2.75 ± 1.98, P = 0.044) in the injured side when compared to the non-injured and 26 gait parameters were shown difference in group A. In group B, the muscle strength of VL shown decreased (VL: 381.23 ± 142.07 vs 603.9 ± 192.72, P < 0.001) and the division of location of 30° became larger (7.62 ± 4.98 vs 4.33 ± 3.24, P = 0.028) in the injured side when compared to the non-injured side and there were eight gait parameters that showed differences. In group C, the muscle strength and proprioception showed no differences and only 16 gait parameters showed differences between the bilateral limbs.
The results proved the deterioration of proprioception in 30° of injured side will not recover and non-injury side and will become worse after 1 year from the injury; among the VL, VM, and RF, the recovery rate of VL is the slowest and bilateral straight leg raising (SLR) (30°) is the best way to train it; the gait stability will be worse after 1 year from the injury. Therefore, we suggest that the training for proprioception in 30° and VL are important for the rehabilitation, and the ACL reconstruction should be performed within 1 year.
通过步态分析、表面肌电图（SEMG）和本体感觉测试来研究前交叉韧带（ACL）损伤患者的生物力学特征，并根据结果提供康复建议。
在这项回顾性队列研究中，共招募了 90 名单侧 ACL 损伤的成年人，年龄 19 至 45 岁（66 名男性和 24 名女性，平均年龄：30.03±7.91 岁），时间范围为 2018 年 5 月至 2019 年 7 月。根据受伤后的时间，他们被分为三组：A 组（3 周至 1.5 个月）、B 组（1.5 个月至 1 年）和 C 组（1 年以上）。从双侧股直肌（RF）、股内侧肌（VM）和股外侧肌（VL）采集表面肌电图信号，使用均方根（RMS）评估肌肉活动。使用 SEMG 分析肌肉功能，步态分析评估行走稳定性，平衡和位置评估分析本体感觉。
通过与非受伤侧相比，所有肌肉力量均显示下降（RF：239.94±129.70 对 364.81±148.98，P=0.001；VM：298.88±175.41 对 515.79±272.49，P=0.001；VL：389.54±157.97 对 594.28±220.31，P<0.001），本体感觉的划分变得更大（双脚站立位置：7.79±1.57 对 6.33±1.49，P=0.001；单脚站立位置：8.13±0.84 对 7.1±0.57，P=0.003；30°方差：6.96±3.15 对 4.45±1.67，P=0.03；60°方差：4.64±3.38 对 2.75±1.98，P=0.044），在受伤侧与非受伤侧相比，26 个步态参数存在差异。在 B 组中，VL 的肌肉力量显示下降（VL：381.23±142.07 对 603.9±192.72，P<0.001），30°的位置划分变大（7.62±4.98 对 4.33±3.24，P=0.028），在受伤侧与非受伤侧相比，8 个步态参数存在差异。在 C 组中，肌肉力量和本体感觉无差异，双侧直腿抬高（30°）是训练它的最佳方法。受伤 1 年后，步态稳定性变差。
研究结果证实，受伤侧 30°的本体感觉恶化不会恢复，且非受伤侧会变得更差；在 VL、VM 和 RF 中，VL 的恢复速度最慢，双侧直腿抬高（30°）是训练它的最佳方法；受伤 1 年后，步态稳定性会变差。因此，我们建议对 30°和 VL 的本体感觉进行训练对康复很重要，ACL 重建应在 1 年内进行。
