ACL 重建术后 6 个月双侧下肢落地时的膝关节动态刚度。
Dynamic knee joint stiffness during bilateral lower extremity landing 6 months after ACL reconstruction.
机构信息
School of Health Professions, University of Texas Medical Branch, Galveston, TX, United States; College of Health Sciences, University of Kentucky, Lexington, KY, United States; College of Education, University of Kentucky, Lexington, KY, United States.
College of Education, University of Kentucky, Lexington, KY, United States; Orthopedic Surgery, University of Kentucky, Lexington, KY, United States.
出版信息
Knee. 2023 Jun;42:73-81. doi: 10.1016/j.knee.2023.02.017. Epub 2023 Mar 11.
BACKGROUND
Anterior cruciate ligament (ACL) reconstructions are associated with long-term functional impairments. Improved understanding of dynamic knee joint stiffness and work may provide insights to help address these poor outcomes. Defining the relationship between knee stiffness, work and quadriceps muscle symmetry may reveal therapeutic targets. The purposes of this study were to investigate between-limb differences in knee stiffness and work during early phase landing 6-months after an ACL reconstruction. Additionally, we investigated relationships among symmetry of knee joint stiffness and work during early-phase landing and quadriceps muscle performance symmetry.
METHODS
Twenty-nine participants (17 M, 20.0 ± 5.3 years) were tested 6-months after ACL reconstruction. Motion capture analysis was used to assess between-limb differences in knee stiffness and work during the first 60 ms of a double-limb landing. Quadriceps peak strength and rate of torque development (RTD) were assessed with isometric dynamometry. Paired t-tests and Pearson's product moment correlations were used to determine between-limb differences of knee mechanics and correlations of symmetry respectively.
FINDINGS
Knee joint stiffness and work were significantly reduced (p < 0.01, p < 0.01) in the surgical limb (0.021 ± 0.01 Nm*(degkgm), -0.085 ± 0.06 J*(kgm) ) compared to the uninvolved limb (0.045 ± 0.01 Nm(degkgm), -0.256 ± 0.10 J*(kg*m) ). Greater knee stiffness (51 ± 22%) and work (35 ± 21%) symmetry were significantly associated with greater RTD symmetry (44.5 ± 19.4%) (r = 0.43, p = 0.02; r = 0.45, p = 0.01) but not peak torque symmetry (62.9 ± 16.1%) (r = 0.32, p = 0.10; r = 0.34, p = 0.10).
INTERPRETATION
Dynamic stiffness and energy absorption are lower in the surgical knee during landing from a jump. Therapeutic interventions that target increasing quadriceps RTD may help optimize dynamic stability and energy absorption during landing.
背景
前交叉韧带（ACL）重建后与长期的功能障碍有关。更好地了解动态膝关节刚度和功，可能有助于解决这些不良结果。定义膝关节刚度、功和股四头肌对称性之间的关系，可能揭示治疗靶点。本研究的目的是探讨 ACL 重建后 6 个月时早期着地阶段双侧膝关节刚度和功的差异。此外，我们还研究了早期着地阶段膝关节刚度和功对称性与股四头肌肌肉性能对称性之间的关系。
方法
29 名参与者（17 名男性，20.0 ± 5.3 岁）在 ACL 重建后 6 个月接受测试。运动捕捉分析用于评估双侧膝关节刚度和功在双足着地的前 60ms 内的差异。使用等速测力法评估股四头肌的峰值强度和扭矩发展率（RTD）。使用配对 t 检验和 Pearson 积差相关系数分别确定膝关节力学的双侧差异和对称性的相关性。
结果
手术侧膝关节刚度和功显著降低（p<0.01，p<0.01）（0.021±0.01Nm*（degkgm），-0.085±0.06J*（kgm）），与未受累侧（0.045±0.01Nm（degkgm），-0.256±0.10J*（kg*m））相比。较大的膝关节刚度（51±22%）和功（35±21%）对称性与较大的 RTD 对称性（44.5±19.4%）显著相关（r=0.43，p=0.02；r=0.45，p=0.01），但与峰值扭矩对称性（62.9±16.1%）无关（r=0.32，p=0.10；r=0.34，p=0.10）。
解释
从跳跃着地时，手术膝关节的动态刚度和能量吸收较低。针对增加股四头肌 RTD 的治疗干预可能有助于优化着地阶段的动态稳定性和能量吸收。
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