Kotsifaki Argyro, Whiteley Rod, Van Rossom Sam, Korakakis Vasileios, Bahr Roald, Sideris Vasileios, Graham-Smith Philip, Jonkers Ilse
Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium.
Br J Sports Med. 2022 Mar;56(5):249-256. doi: 10.1136/bjsports-2020-103677. Epub 2021 Mar 9.
We evaluated the lower limb status of athletes after anterior cruciate ligament reconstruction (ACLR) during the propulsion and landing phases of a single leg hop for distance (SLHD) task after they had been cleared to return to sport. We wanted to evaluate the biomechanical components of the involved (operated) and uninvolved legs of athletes with ACLR and compare these legs with those of uninjured athletes (controls).
We captured standard video-based three-dimensional motion and electromyography (EMG) in 26 athletes after ACLR and 23 healthy controls during SLHD and calculated lower limb and trunk kinematics. We calculated lower limb joint moments and work using inverse dynamics and computed lower limb muscle forces using an EMG-constrained musculoskeletal modelling approach. Between-limb (within ACLR athletes) and between-group differences (between ACLR athletes and controls) were evaluated using paired and independent sample t-tests, respectively.
Significant differences in kinematics (effect sizes ranging from 0.42 to 1.56), moments (0.39 to 1.08), and joint work contribution (0.55 to 1.04) were seen between the involved and uninvolved legs, as well as between groups. Athletes after ACLR achieved a 97%±4% limb symmetry index in hop distance but the symmetry in work done by the knee during propulsion was only 69%. During landing, the involved knee absorbed less work than the uninvolved, while the uninvolved knee absorbed more work than the control group. Athletes after ACLR compensated for lower knee work with greater hip work contribution and by landing with more hip flexion, anterior pelvis tilt, and trunk flexion.
Symmetry in performance on a SLHD test does not ensure symmetry in lower limb biomechanics. The distance hopped is a poor measure of knee function, and largely reflects hip and ankle function. Male athletes after ACLR selectively unload the involved limb but outperform controls on the uninvolved knee.
我们评估了前交叉韧带重建（ACLR）术后运动员在单腿跳远距离（SLHD）任务的推进和着陆阶段被批准恢复运动后的下肢状况。我们想评估ACLR运动员患侧（手术侧）和未患侧下肢的生物力学组成部分，并将这些下肢与未受伤运动员（对照组）的下肢进行比较。
我们在26名ACLR术后运动员和23名健康对照者进行SLHD测试期间，采集了基于标准视频的三维运动和肌电图（EMG）数据，并计算了下肢和躯干运动学指标。我们使用逆动力学计算下肢关节力矩和功，并使用肌电图约束的肌肉骨骼建模方法计算下肢肌肉力量。分别使用配对和独立样本t检验评估组内（ACLR运动员之间）和组间差异（ACLR运动员与对照组之间）。
患侧和未患侧下肢之间以及两组之间在运动学（效应大小范围为0.42至1.56）、力矩（0.39至1.08）和关节功贡献（0.55至1.04）方面存在显著差异。ACLR术后运动员在跳跃距离上实现了97%±4%的肢体对称指数，但推进过程中膝关节做功的对称性仅为69%。在着陆时，患侧膝关节吸收的功比未患侧少，而未患侧膝关节吸收的功比对照组多。ACLR术后运动员通过增加髋部功贡献以及以更多的髋部屈曲、骨盆前倾和躯干屈曲着陆来补偿膝关节功的降低。
SLHD测试中的表现对称性并不能确保下肢生物力学的对称性。跳跃距离是膝关节功能的一个较差指标，主要反映髋部和踝关节功能。ACLR术后男性运动员选择性地减轻患侧肢体的负荷，但在未患侧膝关节上的表现优于对照组。
