MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
Human Movement Science Curriculum, University of North Carolina at Chapel Hill.
J Athl Train. 2023 Jun 1;58(6):542-553. doi: 10.4085/1062-6050-0700.20.
Individuals who undergo anterior cruciate ligament reconstruction (ACLR) are at higher risk of posttraumatic osteoarthritis. Altered joint tissue loading caused by aberrant gait biomechanics leads to deleterious changes in joint health linked to the onset of posttraumatic osteoarthritis. Knee braces have been used to modify joint tissue loading in individuals with joint injury, yet the effects of walking with a brace after ACLR on biomechanical, biochemical, and structural cartilage outcomes are unknown.
To compare biomechanical, biochemical, and structural outcomes between braced and nonbraced walking in individuals with ACLR.
Crossover study.
Research laboratory.
A total of 34 individuals with unilateral ACLR (18 females, 16 males; time since ACLR = 50.1 ± 36.8 months).
INTERVENTION(S): Gait biomechanics were assessed during braced and unbraced conditions on separate days.
MAIN OUTCOME MEASURE(S): Vertical ground reaction force, knee-flexion angle, and internal knee-extension moment waveforms were evaluated throughout the stance phase and compared between conditions. Percentage changes in serum cartilage oligomeric matrix protein (%ΔCOMP) and femoral cartilage cross-sectional area (%ΔCSA) measured via ultrasound were calculated after a 3000-step walking protocol.
Braced walking increased the knee-flexion angle (largest difference = 3.56°; Cohen d effect size = 1.72) and knee-extension moment (largest difference = -0.48% body weight × height; Cohen d effect size = -1.14) compared with nonbraced walking but did not influence vertical ground reaction force. Whereas no difference (P = .20) in %ΔCOMP existed between the braced and nonbraced conditions in the entire cohort (n = 30 with complete blood data), a larger increase (P = .04) in %ΔCOMP was seen during nonbraced than braced walking in individuals who demonstrated increased COMP during nonbraced walking. No difference (P = .86) in %ΔCSA was present between the braced and nonbraced conditions.
Braced walking may improve sagittal-plane gait biomechanics and %ΔCOMP in a subset of individuals who demonstrate a typical increased COMP response to load (ie, increase in COMP) after nonbraced walking.
接受前交叉韧带重建 (ACLR) 的个体患创伤后骨关节炎的风险较高。异常步态生物力学引起的关节组织加载改变导致关节健康的有害变化，从而导致创伤后骨关节炎的发生。膝关节支具已用于改变关节损伤个体的关节组织加载，但 ACLR 后使用支具行走对生物力学、生化和结构软骨结果的影响尚不清楚。
比较 ACLR 后支具和非支具行走的生物力学、生化和结构结果。
交叉研究。
研究实验室。
共 34 名单侧 ACLR 患者（18 名女性，16 名男性；ACL 重建后时间=50.1±36.8 个月）。
在不同的日子里，在支具和非支具条件下评估步态生物力学。
在整个站立阶段评估垂直地面反作用力、膝关节屈曲角度和膝关节内伸肌力矩波形，并在条件之间进行比较。通过超声测量的软骨寡聚基质蛋白的血清百分比变化（%ΔCOMP）和股骨软骨横截面积的百分比变化（%ΔCSA），在进行 3000 步行走方案后进行计算。
与非支具行走相比，支具行走增加了膝关节屈曲角度（最大差值=3.56°；Cohen d 效应大小=1.72）和膝关节伸肌力矩（最大差值=-0.48%体重×身高；Cohen d 效应大小=-1.14），但垂直地面反作用力没有差异。在整个队列（n=30 名具有完整血液数据的患者）中，支具和非支具条件之间的%ΔCOMP 没有差异（P=0.20），但在非支具行走时 COMP 增加的患者中，非支具行走比支具行走时%ΔCOMP 增加更大（P=0.04）。支具和非支具条件之间的%ΔCSA 没有差异（P=0.86）。
支具行走可能会改善矢状面步态生物力学和%ΔCOMP，在非支具行走后出现典型 COMP 反应增加（即 COMP 增加）的亚组个体中。
