Higbie Steven, Kleihege Jacquelyn, Duncan Brian, Lowe Walter R, Bailey Lane
Memorial Hermann Ironman Sports Medicine Institute.
McGovern Medical School at UT Health.
Int J Sports Phys Ther. 2021 Oct 1;16(5):1295-1301. doi: 10.26603/001c.27346. eCollection 2021.
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.
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。
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