Di Giminiani Riccardo, Marinelli Stefano, La Greca Stefano, Di Blasio Andrea, Angelozzi Massimo, Cacchio Angelo
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
Department of Medicine and Aging Sciences, 'G. D'Annunzio' University of Chieti-Pescara, 66013 Chieti, Italy.
Biology (Basel). 2023 Aug 26;12(9):1173. doi: 10.3390/biology12091173.
Despite the advancement of diagnostic surgical techniques in anterior cruciate ligament (ACL) reconstruction and rehabilitation protocols following ACL injury, only half of the athletes return to sports at a competitive level. A major concern is neuromechanical dysfunction, which occurs with injuries persisting in operated and non-operated legs following ACL rehabilitation. One of the criteria for a safe return to sports participation is based on the maximal voluntary isometric contraction (MVIC) performed unilaterally and a comparison between the 'healthy knee' and the 'operated knee'. The present study aimed to investigate MVIC in athletes following ACL rehabilitation during open kinetic chain exercise performed unilaterally and bilateral exercises. Twenty subjects participated in the present investigation: 10 male athletes of regional-national level (skiers, rugby, soccer, and volleyball players) who were previously operated on one knee and received a complete rehabilitation protocol (for 6-9 months) were included in the ACL group (age: 23.4 ± 2.11 years; stature: 182.0 ± 9.9 cm; body mass: 78.6 ± 9.9 kg; body mass index: 23.7 ± 1.9 kg/m), and 10 healthy male athletes formed the control group (CG: age: 24.0 ± 3.4 years; stature: 180.3 ± 10.7 cm; body mass: 74.9 ± 13.5 kg; body mass index: 22.8 ± 2.7 kg/m). MVICs synchronised with electromyographic (EMG) activity (recorded on the vastus lateralis, vastus medialis, and biceps femoris muscles) were performed during unilateral and bilateral exertions. The rate of force development (RFD) and co-activation index (CI) were also calculated. The differences in the MVIC and RFD between the two legs within each group were not significant ( > 0.05). Vastus lateralis EMG activity during MVIC and biceps femoris EMG activity during RFD were significantly higher in the operated leg than those in the non-operated leg when exertion was performed bilaterally ( < 0.05). The CI was higher in the operated leg than that in the non-operated leg when exertion was performed bilaterally ( < 0.05). Vice versa, vastus medialis EMG activity during RFD was significantly higher in the right leg than that in the left leg when exertion was performed bilaterally ( < 0.05) in the CG. MVICs performed bilaterally represent a reliability modality for highlighting neuromechanical asymmetries. This bilateral exercise should be included in the criteria for a safe return to sports following ACL reconstruction.
尽管前交叉韧带（ACL）重建的诊断性手术技术以及ACL损伤后的康复方案有所进步，但只有一半的运动员能够恢复到有竞争力的运动水平。一个主要问题是神经力学功能障碍，这种障碍在ACL康复后，手术侧和非手术侧的损伤持续存在时都会出现。安全恢复运动参与的标准之一是基于单侧进行的最大自主等长收缩（MVIC）以及“健康膝关节”与“手术膝关节”之间的比较。本研究旨在调查ACL康复后的运动员在单侧和双侧开链运动期间的MVIC。20名受试者参与了本研究：ACL组包括10名地区 - 国家级水平的男性运动员（滑雪者、橄榄球运动员、足球运动员和排球运动员），他们之前一侧膝关节接受过手术并接受了完整的康复方案（6 - 9个月）（年龄：23.4±2.11岁；身高：182.0±9.9厘米；体重：78.6±9.9千克；体重指数：23.7±1.9千克/平方米），10名健康男性运动员组成对照组（CG：年龄：24.0±3.4岁；身高：180.3±10.7厘米；体重：74.9±13.5千克；体重指数：22.8±2.7千克/平方米）。在单侧和双侧用力过程中进行了与肌电图（EMG）活动同步的MVIC（记录在股外侧肌、股内侧肌和股二头肌上）。还计算了力量发展速率（RFD）和共同激活指数（CI）。每组内两腿之间的MVIC和RFD差异不显著（>0.05）。双侧用力时，手术侧腿在MVIC期间的股外侧肌EMG活动和在RFD期间的股二头肌EMG活动显著高于非手术侧腿（<0.05）。双侧用力时，手术侧腿的CI高于非手术侧腿（<0.05）。反之，在CG中，双侧用力时，RFD期间右腿的股内侧肌EMG活动显著高于左腿（<0.05）。双侧进行的MVIC是突出神经力学不对称性的一种可靠方式。这种双侧运动应纳入ACL重建后安全恢复运动的标准中。
