Department of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark.
Department of Orthopedic Surgery, Vejle Hospital, Vejle, Denmark.
Am J Sports Med. 2020 Nov;48(13):3214-3223. doi: 10.1177/0363546520960108. Epub 2020 Oct 20.
Anterior cruciate ligament (ACL) rupture is a serious injury with a high prevalence worldwide, and subsequent ACL reconstructions (ACLR) appear to be most commonly performed using hamstring-derived (semitendinosus tendon) autografts. Recovery of maximal muscle strength to ≥90% of the healthy contralateral limb is considered an important criterion for safe return to sports. However, the speed of developing muscular force (ie, the rate of force development [RFD]) is also important for the performance of many types of activities in sports and daily living, yet RFD of the knee extensor and flexor muscles has apparently never been examined in patients who undergo ACLR with hamstring autograft (HA).
To examine potential deficits in RFD, maximal muscle strength (ie, maximal voluntary isometric contraction [MVIC]), and functional capacity of ACLR-HA limbs in comparison with the healthy contralateral leg and matched healthy controls 3 to 9 months after surgery.
Cross-sectional study; Level of evidence: 3.
A total of 23 young patients who had undergone ACLR-HA 3 to 9 months earlier were matched by age to 14 healthy controls; both groups underwent neuromuscular screening. Knee extensor and flexor MVIC and RFD, as well as functional capacity (single-leg hop for distance [SLHD] test, timed single-leg sit-to-stand [STS] test), were assessed on both limbs. Furthermore, patient-reported knee function (Knee injury and Osteoarthritis Outcome Score) was assessed.
Knee extensor and flexor MVIC and RFD were markedly compromised in ACLR-HA limbs compared with healthy contralateral limbs (MVIC for extensor and flexor, 13% and 26%, respectively; RFD, 14%-17% and 32%-39%) and controls (MVIC, 16% and 31%; RFD, 14%-19% and 30%-41%) ( < .05-.001). Further, ACLR-HA limbs showed reduced functional capacity (reduced SLHD and STS performance) compared with contralateral limbs (SLHD, 11%; STS, 14%) and controls (SLHD, 20%; STS, 31%) ( < .01-.001). Strength (MVIC) and functional (SLHD) parameters were positively related to the duration of time after surgery ( < .05), although this relationship was not observed for RFD and STS.
Knee extensor and flexor RFD and maximal strength, as well as functional single-leg performance, remained substantially reduced in ACLR-HA limbs compared with noninjured contralateral limbs and healthy controls 3 to 9 months after reconstructive surgery.
前交叉韧带（ACL）撕裂是一种全球性高发的严重损伤，随后进行的 ACL 重建（ACLR）似乎最常使用源自腘绳肌（半腱肌腱）的自体移植物。恢复至健侧肢体最大肌力的≥90%被认为是安全重返运动的重要标准。然而，肌肉力量的发展速度（即力量发展率[RFD]）对于运动和日常生活中许多类型活动的表现也很重要，但 ACLR 后使用腘绳肌腱自体移植物（HA）的患者的膝关节伸肌和屈肌的 RFD 显然从未被检测过。
与健侧肢体和匹配的健康对照组相比，在手术后 3 至 9 个月时，检查 ACLR-HA 肢体的 RFD、最大肌肉力量（即最大自主等长收缩[MVIC]）和功能能力是否存在潜在缺陷。
横断面研究；证据水平：3 级。
共有 23 名在 ACLR-HA 术后 3 至 9 个月的年轻患者按年龄与 14 名健康对照组相匹配；两组均接受神经肌肉筛查。在双侧肢体上评估膝关节伸肌和屈肌的 MVIC 和 RFD，以及功能能力（单腿跳距离[SLHD]测试、单腿坐站时间[STS]测试）。此外，还评估了患者的膝关节功能（膝关节损伤和骨关节炎结果评分）。
与健侧肢体相比，ACL-RHA 肢体的膝关节伸肌和屈肌的 MVIC 和 RFD 明显受损（伸肌和屈肌的 MVIC 分别为 13%和 26%；RFD 为 14%-17%和 32%-39%），与对照组相比（MVIC 为 16%和 31%；RFD 为 14%-19%和 30%-41%）（<.05-.001）。此外，ACL-RHA 肢体的功能能力（SLHD 和 STS 表现降低）较健侧肢体（SLHD 降低 11%；STS 降低 14%）和对照组（SLHD 降低 20%；STS 降低 31%）（<.01-.001）降低。（<.05-.001）。虽然 RFD 和 STS 没有观察到这种关系，但力量（MVIC）和功能（SLHD）参数与手术后时间的持续时间呈正相关（<.05）。
与非受伤的健侧肢体和健康对照组相比，在 ACLR 重建后 3 至 9 个月，ACL-RHA 肢体的膝关节伸肌和屈肌的 RFD 和最大力量以及单腿功能表现仍然明显降低。
