等速股四头肌对称性有助于在前交叉韧带重建后决定是否重返跑步。
Isokinetic quadriceps symmetry helps in the decision to return to running after anterior cruciate ligament reconstruction.
机构信息
Physical medicine and rehabilitation center, university hospital of Nantes, CHU Nantes, Nantes, France; Service de médecine du sport, university hospital of Nantes, CHU Nantes, Nantes, France; Inserm UMR U1229/RMeS, regenerative medicine and skeleton - Nantes university, Nantes, France.
Inter-university laboratory of human movement science (LIBM EA 7424), university of Lyon, university Jean-Monnet, 42023 Saint-Étienne, France; Department of clinical and exercise physiology, sports medicine unit, faculty of medicine, university hospital of Saint-Etienne, Saint-Étienne, France.
出版信息
Ann Phys Rehabil Med. 2022 Jun;65(4):101543. doi: 10.1016/j.rehab.2021.101543. Epub 2021 Nov 14.
BACKGROUND
After anterior cruciate ligament reconstruction (ACLR), the decision to allow a return to running is empirical, and the post-operative delay is the most-used criterion. The Quadriceps isokinetic-strength Limb Symmetry Index (Quadriceps LSI), with a cutoff of 60%, could be a useful criterion.
OBJECTIVE
To determine the association between a Quadriceps LSI≥60% and return to running after ACLR.
METHODS
Over a 10-year period, we retrospectively included 470 patients who underwent ACLR. Four months after ACLR, participants performed an isokinetic test; quadriceps concentric peak torque was used to calculate the Quadriceps LSI at 60̊/s. With a Quadriceps LSI≥60%, a return to running was suggested. At 6 months after ACLR, participants were clinically evaluated for a return to sport and post-operative middle-term complications. A multivariable predictive model was built to assess the efficiency diagnosis of this cutoff in order to consider cofounding factors. Quadriceps LSI cutoff≥60% was assessed with sensitivity, specificity and the area under the receiver operating characteristic curve (AUC).
RESULTS
According to our decision-making process with the 60% Quadriceps LSI cutoff at 60̊/s, 285 patients were authorized to return to running at 4 months after ACLR and 185 were not, but 21% (n=59) and 24% (n=45), respectively, were not compliant with the recommendation. No iterative autograft rupture or meniscus pathology occurred at 6 months of follow-up. On multivariable logistic regression analysis, a return to running by using the 60% Quadriceps LSI cutoff was associated with undergoing the hamstring strand procedure (odds ratio 2.60, 95% confidence interval [CI] 1.75-3.84; P<0.0001) and the absence of knee complications (1.18, 1.07-1.29; P=0.001) at 4 months. The sensitivity and specificity of the 60% Quadriceps LSI cutoff were 83% and 70%, respectively. The AUC was 0.840 (95% CI 0.803-0.877).
CONCLUSIONS
Using the 60% cutoff of the isokinetic Quadriceps LSI at 4 months after ACLR could help in the decision to allow a return to running.
背景
在前交叉韧带重建（ACLR）后，允许恢复跑步的决定是经验性的，术后延迟是最常用的标准。股四头肌等速力量肢体对称指数（Quadriceps LSI），截值为 60%，可能是一个有用的标准。
目的
确定 ACLR 后股四头肌 LSI≥60%与恢复跑步之间的关系。
方法
在 10 年期间，我们回顾性纳入了 470 名接受 ACLR 的患者。ACL 重建后 4 个月，参与者进行了等速测试；股四头肌向心峰值扭矩用于计算 60/s 时的股四头肌 LSI。股四头肌 LSI≥60%，建议恢复跑步。在 ACLR 后 6 个月，对参与者进行临床评估，以确定是否恢复运动以及术后中期并发症。建立多变量预测模型，以评估该截值的效率诊断，以考虑混杂因素。使用灵敏度、特异性和接收器操作特征曲线下面积（AUC）评估 60%股四头肌 LSI 截值。
结果
根据我们在 60/s 时使用 60%股四头肌 LSI 截值的决策过程，285 名患者在 ACLR 后 4 个月被授权恢复跑步，而 185 名患者未被授权，但分别有 21%（n=59）和 24%（n=45））不遵守建议。在 6 个月的随访中，没有发生迭代自体移植物破裂或半月板病变。多变量逻辑回归分析显示，使用 60%股四头肌 LSI 截值恢复跑步与进行腘绳肌腱手术（比值比 2.60，95%置信区间 [CI] 1.75-3.84；P<0.0001）和膝关节无并发症（1.18，1.07-1.29；P=0.001）相关在 4 个月时。60%股四头肌 LSI 截值的灵敏度和特异性分别为 83%和 70%。AUC 为 0.840（95%CI 0.803-0.877）。
结论
在前交叉韧带重建后 4 个月使用等速股四头肌 LSI 的 60%截值有助于决定是否允许恢复跑步。
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