高需求任务表明，ACL 重建并不是控制胫骨旋转范围的唯一因素：一项初步研究。
High-demand tasks show that ACL reconstruction is not the only factor in controlling range of tibial rotation: a preliminary investigation.
机构信息
Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands.
Department of Human Movement Science, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RM, Groningen, The Netherlands.
出版信息
J Orthop Surg Res. 2023 Mar 13;18(1):194. doi: 10.1186/s13018-023-03639-2.
BACKGROUND
Excessive range of tibial rotation (rTR) may be a reason why athletes cannot return to sports after ACL reconstruction (ACLR). After ACLR, rTR is smaller in reconstructed knees compared to contralateral knees when measured during low-to-moderate-demand tasks. This may not be representative of the amount of rotational laxity during sports activities. The purpose of this study is to determine whether rTR is increased after ACL injury compared to the contralateral knee and whether it returns to normal after ACLR when assessed during high-demand hoptests, with the contralateral knee as a reference.
METHODS
Ten ACL injured subjects were tested within three months after injury and one year after reconstruction. Kinematic motion analysis was conducted, analysing both knees. Subjects performed a level-walking task, a single-leg hop for distance and a side jump. A paired t-test was used to detect a difference between mean kinematic variables before and after ACL reconstruction, and between the ACL-affected knees and contralateral knees before and after reconstruction.
RESULTS
RTR was greater during high-demand tasks compared to low-demand tasks. Pre-operative, rTR was smaller in the ACL-deficient knees compared to the contralateral knees during all tests. After ACLR, a greater rTR was seen in ACL-reconstructed knees compared to pre-operative, but a smaller rTR compared to the contralateral knees, even during high-demand tasks.
CONCLUSION
The smaller rTR, compared to the contralateral knee, seen after a subacute ACL tear may be attributed to altered landing technique, neuromuscular adaptation and fear of re-injury. The continued reduction in rTR one year after ACLR may be a combination of this neuromuscular adaptation and the biomechanical impact of the reconstruction.
TRIAL REGISTRATION
The trial was registered in the Dutch Trial Register (NTR: www.trialregister.nl , registration ID NL7686).
背景
过度的胫骨旋转范围（rTR）可能是运动员在 ACL 重建（ACLR）后无法重返运动的原因。在 ACLR 后，与对侧膝关节相比，在中低需求任务中测量时，重建膝关节的 rTR 较小。这可能不能代表运动活动期间的旋转松弛度。本研究的目的是确定 ACL 损伤后 rTR 是否比对侧膝关节增加，以及在高需求 hop 测试中评估时 ACLR 后是否恢复正常，以对侧膝关节为参照。
方法
10 名 ACL 受伤的受试者在受伤后三个月内和重建后一年进行测试。进行运动分析，分析双侧膝关节。受试者进行了平步行走任务、单腿跳远和侧跳。使用配对 t 检验检测 ACL 重建前后平均运动变量的差异，以及 ACL 受累膝关节与重建前后对侧膝关节的差异。
结果
高需求任务中的 rTR 大于低需求任务。在所有测试中，术前 ACL 缺陷膝关节的 rTR 均小于对侧膝关节。ACLR 后，与术前相比，ACL 重建膝关节的 rTR 更大，但与对侧膝关节相比，rTR 更小，即使在高需求任务中也是如此。
结论
与对侧膝关节相比，亚急性 ACL 撕裂后 rTR 较小可能归因于改变的着陆技术、神经肌肉适应和对再受伤的恐惧。ACLR 后一年 rTR 的持续减少可能是这种神经肌肉适应和重建的生物力学影响的组合。
试验注册
该试验在荷兰试验注册处（NTR：www.trialregister.nl，注册 ID NL7686）注册。
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