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在 ACL 重建术后恢复运动决策中利用髋关节外展力量与体重的比值

Utilizing Hip Abduction Strength to Body-Weight Ratios in Return to Sport Decision-Making After ACL Reconstruction.

作者信息

Higbie Steven, Kleihege Jacquelyn, Duncan Brian, Lowe Walter R, Bailey Lane

机构信息

Memorial Hermann Ironman Sports Medicine Institute.

McGovern Medical School at UT Health.

出版信息

Int J Sports Phys Ther. 2021 Oct 1;16(5):1295-1301. doi: 10.26603/001c.27346. eCollection 2021.


DOI:10.26603/001c.27346
PMID:34631250
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8486405/
Abstract

BACKGROUND: Despite the association between hip abduction weakness and non-contact anterior cruciate ligament (ACL) injury, hip abduction strength is rarely considered in return to sport decision-making following ACL reconstruction (ACLR). HYPOTHESIS/PURPOSE: The purpose of this study was to compare self-reported function, objective functional test performance, and re-injury rates in patients with high (≥33%) versus low (<33% ) isometric hip abduction strength to body weight (BW) ratios when returning to activity following ACLR. STUDY DESIGN: Cohort study. METHODS: Data were gathered from a single-surgeon database and included baseline demographics. Clinical outcomes were assessed at the time of release to activity and included self-reported outcomes and a functional testing battery. Isometric hip abduction strength was obtained using a handheld dynamometer. Groups were dichotomized into those with low vs high strength to BW ratios. Two-year follow-up was performed using the single assessment numeric evaluation (SANE). Data were analyzed using univariate general linear models with an alpha level of .05. RESULTS: Of the 528 enrolled patients, 364 (68.9%) demonstrated a low strength to BW ratio. Baseline comparisons revealed more females and higher BMI (P <.05) in the <33% group. At release to activity, the <33% BW group demonstrated lower International Knee Documentation Committee survey scores (88.2 ± 13.6 vs 93.5 ± 10.3, P<.01), ACL-Return to Sport After Injury (76.2 ± 15.4 vs 88.5 ± 16.9, P<.01) scores, and isokinetic hamstring peak torque (P=.04). At 2-years, the <33% group reported lower SANE scores (83.3 ± 21.1 vs 92.83 ± 11.4, P=.05) with no significant differences in re-injuries. CONCLUSION: Patients with low hip abduction strength to BW ratios demonstrated lower subjective function, psychological readiness, and isokinetic hamstring peak torque when completing functional testing following ACLR. Subjective deficits remained at 2-years. LEVEL OF EVIDENCE: Level 3. KEY TERMS: ACL injury, hip abduction strength, return to sport, strength ratio. CLINICAL RELEVANCE: Assessing isometric hip abduction strength to body weight ratio may be beneficial in determining readiness to return to sport following ACL reconstruction. WHAT IS KNOWN ABOUT THE SUBJECT: Three prospective studies have provided conflicting evidence regarding the relationship between hip abduction strength and ACL injury. A clinical cut-point of hip abduction strength:BW ratio <35.4% has been suggested to identify athletes at risk of sustaining a non-contact ACL injury. To our knowledge no studies have examined isometric hip abduction strength:BW ratios in athletes attempting to return to sport following ACLR. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: This study examines the potential for hip abduction strength:BW ratio to be included as an additional metric in return to sport testing batteries.

摘要

背景:尽管髋关节外展无力与非接触性前交叉韧带(ACL)损伤之间存在关联,但在ACL重建(ACLR)术后恢复运动的决策中,很少考虑髋关节外展力量。 假设/目的:本研究的目的是比较ACLR术后恢复活动时,等长髋关节外展力量与体重(BW)比值高(≥33%)和低(<33%)的患者自我报告的功能、客观功能测试表现及再损伤率。 研究设计:队列研究。 方法:数据收集自一个单一外科医生的数据库,包括基线人口统计学资料。在恢复活动时评估临床结局,包括自我报告的结局和一组功能测试。使用手持测力计获得等长髋关节外展力量。将研究对象分为力量与体重比值低和高的两组。采用单评估数值评估(SANE)进行两年随访。使用α水平为0.05的单变量一般线性模型分析数据。 结果:在528名入组患者中,364名(68.9%)表现出力量与体重比值低。基线比较显示,<33%组女性更多,体重指数更高(P<0.05)。恢复活动时,<33%体重组的国际膝关节文献委员会调查评分更低(88.2±13.6对93.5±10.3,P<0.01),ACL损伤后恢复运动(76.2±15.4对88.5±16.9,P<0.01)评分更低,等速腘绳肌峰值扭矩更低(P=0.04)。在两年时,<33%组报告的SANE评分更低(83.3±21.1对92.83±11.4,P=0.05),再损伤方面无显著差异。 结论:ACLR术后进行功能测试时,髋关节外展力量与体重比值低的患者表现出更低的主观功能、心理准备度和等速腘绳肌峰值扭矩。主观缺陷在两年时仍然存在。 证据水平:3级。 关键词:ACL损伤;髋关节外展力量;恢复运动;力量比值。 临床相关性:评估等长髋关节外展力量与体重比值可能有助于确定ACL重建术后恢复运动的准备情况。 关于该主题已知的信息:三项前瞻性研究提供了关于髋关节外展力量与ACL损伤关系的相互矛盾的证据。有人建议将髋关节外展力量:体重比值<35.4%作为临床切点,以识别有非接触性ACL损伤风险的运动员。据我们所知,尚无研究在试图ACLR术后恢复运动的运动员中检验等长髋关节外展力量:体重比值。 本研究对现有知识的补充:本研究探讨了髋关节外展力量:体重比值作为恢复运动测试指标之一的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d010/8486405/2e4da0877fe1/ijspt_2021_16_5_27346_68112.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d010/8486405/2e4da0877fe1/ijspt_2021_16_5_27346_68112.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d010/8486405/2e4da0877fe1/ijspt_2021_16_5_27346_68112.jpg

相似文献

[1]
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[2]
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引用本文的文献

[1]
Hip Strength Recovery After Anterior Cruciate Ligament Reconstruction.

Orthop J Sports Med. 2023-7-7

[2]
Relationship Between Bone Bruise Volume and Patient Outcomes After ACL Reconstruction.

Orthop J Sports Med. 2023-2-24

[3]
Global research status of anterior cruciate ligament reconstruction: a bibliometric analysis.

EFORT Open Rev. 2022-12-21

本文引用的文献

[1]
Psychological Readiness to Return to Sport Is Associated With Second Anterior Cruciate Ligament Injuries.

Am J Sports Med. 2019-2-12

[2]
Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review.

Br J Sports Med. 2019-2-2

[3]
Progression of the Psychological ACL-RSI Score and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Prospective 2-Year Follow-up Study From the French Prospective Anterior Cruciate Ligament Reconstruction Cohort Study (FAST).

Orthop J Sports Med. 2018-12-17

[4]
Greater body mass index and hip abduction muscle strength predict noncontact anterior cruciate ligament injury in female Japanese high school basketball players.

Knee Surg Sports Traumatol Arthrosc. 2018-3-6

[5]
National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury.

J Athl Train. 2018-1-9

[6]
Is There an Association Between Noncontact Anterior Cruciate Ligament Injuries and Decreased Hip Internal Rotation or Radiographic Femoroacetabular Impingement? A Systematic Review.

Arthroscopy. 2017-11-20

[7]
Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs?

J Orthop Sports Phys Ther. 2017-11

[8]
ACL Injury Prevention: What Does Research Tell Us?

Curr Rev Musculoskelet Med. 2017-9

[9]
THE ASSOCIATIONS BETWEEN HIP STRENGTH AND HIP KINEMATICS DURING A SINGLE LEG HOP IN RECREATIONAL ATHLETES POST ACL RECONSTRUCTION COMPARED TO HEALTHY CONTROLS.

Int J Sports Phys Ther. 2017-6

[10]
Hip external rotation strength predicts hop performance after anterior cruciate ligament reconstruction.

Knee Surg Sports Traumatol Arthrosc. 2017-4-4

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