Soma Yuichiro, Mutsuzaki Hirotaka, Yoshioka Tomokazu, Kubota Shigeki, Shimizu Yukiyo, Kanamori Akihiro, Yamazaki Masashi
Department of Rehabilitation Medicine, University of Tsukuba Hospital, Japan.
Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences Hospital, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2022 Feb 1;27:13-18. doi: 10.1016/j.asmart.2021.12.002. eCollection 2022 Jan.
Muscle co-contraction can result in higher joint contact forces, compromising knee joint mobility for stability, thus leading to impaired lower extremity neuromuscular control, delayed return to sports, and increased incidence of secondary anterior cruciate ligament (ACL) injury post-ACL reconstruction. Hybrid assistive limb (HAL) training has the potential to correct impairment of antagonistic or synergistic muscle movement of the knee joint through bioelectric signal feedback from muscle signals with computer processing. We considered that HAL training would contribute to improve peak muscle torque through coordinating or decreasing higher levels of muscle co-contractions and reducing differences between hamstring and quadriceps muscle activity on electromyography (EMG). While playing handball, a 20-year-old female injured her ACL upon landing on one leg. Two months post-injury, she underwent arthroscopic, anatomic single-bundle ACL reconstruction with a semitendinosus tendon autograft. At a 4-month follow-up, she underwent knee HAL training, which was performed once a week for three sessions. EMG data were collected during the evaluations of pre- and post-HAL training. The average muscle amplitude was used to calculate the difference between vastus lateralis (VL) and semitendinosus (ST) muscles, and the muscle co-contraction index (CCI). The CCI reflects the simultaneous activation of antagonistic muscles, which is determined for knee extensor-flexor muscle pairs. Post-knee HAL training, the CCI of the lateral hamstring and quadriceps muscles during extension was lower than that during pre-HAL training in all sessions. However, no differences were found in the CCI for the medial hamstring and quadriceps muscles during extension and flexion pre- and post-knee HAL training. For post-knee HAL training, the difference between VL and ST EMG data during a closed-chain squat was lower than that during pre-HAL training in all sessions. Knee HAL training contributed to improved peak muscle torque through coordinating or decreasing higher levels of muscle co-contractions, and it reduced differences between hamstring and quadriceps muscle activity in the ACL reconstructed leg as depicted by EMG.
肌肉共同收缩会导致更高的关节接触力，为了稳定性而牺牲膝关节的活动度，从而导致下肢神经肌肉控制受损、运动恢复延迟以及前交叉韧带（ACL）重建术后继发ACL损伤的发生率增加。混合辅助肢体（HAL）训练有潜力通过计算机处理肌肉信号的生物电信号反馈来纠正膝关节拮抗肌或协同肌运动的损伤。我们认为HAL训练将有助于通过协调或减少更高水平的肌肉共同收缩以及减少腘绳肌和股四头肌在肌电图（EMG）上的活动差异来提高肌肉峰值扭矩。一名20岁女性在单腿落地时损伤了ACL，当时正在打手球。受伤两个月后，她接受了关节镜下解剖单束ACL重建手术，使用半腱肌腱自体移植。在4个月的随访中，她接受了膝关节HAL训练，每周进行一次，共三次。在HAL训练前后的评估过程中收集EMG数据。使用平均肌肉振幅来计算股外侧肌（VL）和半腱肌（ST）之间的差异以及肌肉共同收缩指数（CCI）。CCI反映拮抗肌的同时激活，是针对膝关节伸肌 - 屈肌对确定的。膝关节HAL训练后，在所有训练阶段，伸展过程中外侧腘绳肌和股四头肌的CCI均低于HAL训练前。然而，在膝关节HAL训练前后，伸展和屈曲过程中内侧腘绳肌和股四头肌的CCI没有差异。对于膝关节HAL训练后，在所有训练阶段，闭链深蹲过程中VL和ST的EMG数据差异均低于HAL训练前。膝关节HAL训练通过协调或减少更高水平的肌肉共同收缩有助于提高肌肉峰值扭矩，并且如EMG所示，它减少了ACL重建腿中腘绳肌和股四头肌的活动差异。
