Sahabuddin Farhah Nadhirah Aiman, Jamaludin Nazatul Izzati, Amir Nurul Hidayah, Shaharudin Shazlin
Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
Department of Translational Health Sciences, Faculty of Health Science, University of Bristol, Bristol, United Kingdom.
PeerJ. 2021 Jul 5;9:e11731. doi: 10.7717/peerj.11731. eCollection 2021.
A range of non-contact injuries such as anterior cruciate ligament tear, and patellofemoral pain syndrome are caused by disordered knee joint loading from excessive dynamic knee valgus (DKV). Previous systematic reviews showed that DKV could be modified through the influence of hip strength and ankle range of motion. Therefore, the purpose of this systematic review was to examine the effects of exercise intervention which involved either top-down or bottom-up kinetic chains on minimizing DKV in male and female adults and adolescents, with and without existing knee pain.
Electronic searches were conducted in SAGE, Science Direct, SCOPUS, and Pubmed. The search strategy consisted of medical subject headings and free-text search keywords, synonyms and variations of 'exercise intervention,' 'knee alignment,' 'dynamic knee valgus', 'knee abduction' that were merged via the Boolean operator 'AND' and 'OR'. The search was conducted on full-text journals that documented the impact of the exercise intervention program involving either the bottom-up or top-down DKV mechanism on the knee kinematics. Furthermore, exercise intervention in this review should last at least one week which included two or three sessions per week. This review also considered both men and women of all ages with a healthy or symptomatic knee problem. The risk of bias of the included studies was assessed by Cochrane risk assessment tool. The protocol of this review was registered at PROSPERO (registration number: CRD42021219121).
Ten studies with a total of 423 participants (male = 22.7%, female = 77.3%; adults = 249, adolescents = 123; pre-adolescent = 51) met the inclusion criteria of this review. Seven studies showed the significant effects of the exercise intervention program (range from two weeks to ten weeks) on reducing DKV. The exercise training in these seven studies focused on muscle groups directly attached to the knee joint such as hamstrings and gastrocnemius. The remaining three studies did not show significant improvement in DKV after the exercise intervention (range between eight weeks to twelve weeks) probably because they focused on trunk and back muscles instead of muscles crossing the knee joint.
Exercises targeting specific knee-joint muscles, either from top-down or bottom-up kinetic chain, are likely to reduce DKV formation. These results may assist athletes and coaches to develop effective exercise program that could minimize DKV and ultimately prevent lower limb injuries.
一系列非接触性损伤，如前交叉韧带撕裂和髌股疼痛综合征，是由过度动态膝外翻（DKV）导致的膝关节负荷紊乱引起的。先前的系统评价表明，DKV可通过髋部力量和踝关节活动范围的影响而得到改善。因此，本系统评价的目的是研究涉及自上而下或自下而上动力链的运动干预对减少成年男女及青少年（无论有无膝关节疼痛）DKV的效果。
在SAGE、Science Direct、SCOPUS和Pubmed数据库进行电子检索。检索策略包括医学主题词和自由文本检索关键词、“运动干预”“膝关节对线”“动态膝外翻”“膝关节外展”的同义词及变体，通过布尔运算符“AND”和“OR”进行合并。检索全文期刊，这些期刊记录了涉及自下而上或自上而下DKV机制的运动干预计划对膝关节运动学的影响。此外，本评价中的运动干预应持续至少一周，每周包括两到三次训练。本评价还纳入了所有年龄段、膝关节健康或有症状的男性和女性。采用Cochrane风险评估工具评估纳入研究的偏倚风险。本评价方案已在PROSPERO注册（注册号：CRD42021219121）。
1０项研究共423名参与者（男性占22.7%，女性占77.3%；成年人249名，青少年123名；青春期前儿童51名）符合本评价的纳入标准。7项研究表明运动干预计划（为期两周至十周）对降低DKV有显著效果。这7项研究中的运动训练集中在直接附着于膝关节的肌肉群，如腘绳肌和腓肠肌。其余3项研究在运动干预后（为期八周至十二周）未显示DKV有显著改善，可能是因为它们侧重于躯干和背部肌肉而非跨越膝关节的肌肉。
针对特定膝关节肌肉的运动，无论是自上而下还是自下而上的动力链，都可能减少DKV的形成。这些结果可能有助于运动员和教练制定有效的运动计划，以尽量减少DKV并最终预防下肢损伤。
