Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.
Sports Med. 2022 Feb;52(2):201-235. doi: 10.1007/s40279-021-01579-7. Epub 2021 Oct 20.
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
膝关节的机械负荷会根据组织（韧带、肌腱、半月板、软骨和骨骼）的局部能力以及这些组织在分子和细胞水平上如何适应这种负荷而产生不同的反应。参与切割、枢轴和跳跃运动会使膝关节容易受伤。在这篇叙述性综述中，我们描述了不同的加载机制，这些机制可能会导致膝关节承受过大的负荷，从而导致韧带、肌肉腱、半月板和软骨损伤或适应性不良。膝关节周围结构受伤（或手术后），康复的主要目标是最大限度地提高患者在当前功能水平上对运动的反应能力，同时最大限度地降低对愈合组织的再损伤风险。临床医生应该清楚地了解特定的受伤组织，康复应该基于对组织愈合限制、膝关节复合体和下肢生物力学、神经肌肉生理学、涉及负重和非负重条件的特定任务活动以及训练原则的了解来驱动。我们提供了一种实用的方法，根据康复过程中对膝关节特定结构的机械负荷谱，为运动练习、功能活动和活动任务规定负荷进展。临床医生可以使用各种负荷干预措施来产生物理应激，以解决身体功能、身体损伤、活动受限和参与受限问题。通过改变力学负荷元素，临床医生可以改变组织适应性，促进运动学习，并解决相应的身体损伤。提供通过力学转导和特异性在组织上产生不同拉伸、压缩和剪切变形的不同负荷，可以促进适当的应激适应，以增加组织能力和损伤耐受性。还提出了监测膝关节康复训练负荷的工具，以评估膝关节对机械负荷的反应性，监测过度的机械负荷，并促进最佳康复。
