Nagelli Christopher, Di Stasi Stephanie, Tatarski Rachel, Chen Albert, Wordeman Samuel, Hoffman Joshua, Hewett Timothy E
Rehabilitation Medicine Research Center, Musculoskeletal Gene Therapy Laboratory, and Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.
Orthop J Sports Med. 2020 Oct 22;8(10):2325967120959347. doi: 10.1177/2325967120959347. eCollection 2020 Oct.
Neuromuscular training (NMT) has been shown to attenuate high-risk biomechanics in uninjured athletes. At the time that athletes return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR), they demonstrate hip biomechanical deficits associated with injury to the reconstructed knee versus the uninjured contralateral knee.
The primary purpose of the study was to examine whether an NMT program can improve single-leg drop (SLD) landing hip biomechanics for athletes after ACLR. Secondarily, we compared the posttraining SLD hip biomechanics of athletes after ACLR with a control group of athletes who also completed the NMT program.
Controlled laboratory study.
A total of 18 ACLR and 10 uninjured athletes were recruited and completed a 12-session NMT program. A knee-specific questionnaire and biomechanics of an SLD task was evaluated for each athlete before and after NMT. Paired tests were used to compare pre- and posttraining International Knee Documentation Committee (IKDC) scores. Repeated-measures analysis of variance (ANOVA) was performed to assess the main effects and interactions of testing session × limb for the ACLR athletes. A 2-way ANOVA was conducted to quantify the interactions and main effects of group × limb.
There was a significant increase ( = .03) in IKDC scores from pre- to posttraining. For the ACLR athletes, there was a significant session × limb interaction for hip external rotation moment ( = .02) and hip abduction angle ( = .013). Despite increases in hip external rotation moment, no significant changes from pre- to posttraining were observed for the involved limbs. No significant changes were observed for hip abduction angle of the involved limbs between training sessions. Significant main effects of session ( < .05) revealed that athletes landed with greater hip excursion, lower hip flexion moment, and lower ground-reaction force after training. The posttraining comparison between the ACLR and control groups found no significant group × limb interactions for any of the hip kinematic or kinetic variables. A significant main effect of group ( < .05) revealed that the ACLR athletes landed with greater hip flexion angle and hip external rotation moment.
ACLR athletes demonstrated an improvement in SLD hip biomechanics and neuromuscular control after participating in an NMT program.
This evidence indicates a potential role for NMT to improve hip biomechanics during an SLD task so as to reduce ACL injury risk.
神经肌肉训练（NMT）已被证明可减轻未受伤运动员的高风险生物力学特征。在前交叉韧带（ACL）重建（ACLR）后运动员恢复运动时，与未受伤的对侧膝关节相比，他们重建的膝关节损伤会表现出髋部生物力学缺陷。
本研究的主要目的是检验NMT计划是否能改善ACLR后运动员单腿下蹲（SLD）落地时的髋部生物力学。其次，我们将ACLR后运动员训练后的SLD髋部生物力学与同样完成NMT计划的对照组运动员进行了比较。
对照实验室研究。
共招募了18名ACLR运动员和10名未受伤的运动员，并完成了一个为期12节的NMT计划。在NMT前后，对每位运动员进行了特定于膝关节的问卷调查和SLD任务的生物力学评估。采用配对检验比较训练前后国际膝关节文献委员会（IKDC）评分。对ACLR运动员进行重复测量方差分析（ANOVA），以评估测试时段×肢体的主要效应和相互作用。进行双向ANOVA以量化组×肢体的相互作用和主要效应。
训练前后IKDC评分有显著提高（P = 0.03）。对于ACLR运动员，髋部外旋力矩（P = 0.02）和髋部外展角度（P = 0.013）存在显著的时段×肢体相互作用。尽管髋部外旋力矩增加，但受累肢体训练前后未观察到显著变化。训练时段之间，受累肢体的髋部外展角度未观察到显著变化。时段的显著主要效应（P < 0.05）表明，训练后运动员落地时髋部偏移更大、髋部屈曲力矩更低、地面反作用力更低。ACLR组与对照组训练后的比较发现，在任何髋部运动学或动力学变量上，组×肢体均无显著相互作用。组的显著主要效应（P < 0.05）表明，ACLR运动员落地时髋部屈曲角度和髋部外旋力矩更大。
ACLR运动员在参加NMT计划后，SLD髋部生物力学和神经肌肉控制有所改善。
这一证据表明NMT在改善SLD任务期间髋部生物力学以降低ACL损伤风险方面具有潜在作用。
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