Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden.
Scand J Med Sci Sports. 2024 Jan;34(1):e14524. doi: 10.1111/sms.14524. Epub 2023 Oct 18.
Investigations of kinetic asymmetries during bilateral squats following anterior cruciate ligament reconstruction (ACLR) are limited to mainly cross-sectional studies and discrete value data extracted at specific knee angles. We assessed loading asymmetries during squats longitudinally throughout rehabilitation using curve analysis and compared patient-reported outcome measures (PROMs) between those with and without asymmetry. Bodyweight squats were performed by 24 individuals (13 females) post-ACLR on three occasions: (1) Early 2.9 (1.1) months; (2) Mid 8.8 (3.1) months; (3) at Return to Sport (RTS) 13.1 (3.6) months; and 29 asymptomatic controls (22 females) once. Time-normalized between-leg asymmetry curves of sagittal plane hip, knee, and ankle moments and vertical ground reaction forces were compared using functional data analysis methods. Individual asymmetrical loading for ACLR was classified when exceeding the 95% confidence interval of controls during ≥50% of the squat. At Early, ACLR had greater asymmetry than controls for knee (15%-100% eccentric phase; 0%-100% concentric) and ankle flexion moments (56%-65% concentric). At Mid, ACLR had greater asymmetry for knee (41%-72% eccentric) and ankle flexion moments (56%-69% concentric). No between-group differences were found at RTS. From Early to RTS, ACLR reduced asymmetry for hip (21%-46% eccentric), knee (27%-58% concentric), and ankle flexion moments (21%-57% eccentric). At Early, 11/24 underloaded their ACLR knee and 1 overloaded compared with controls. At RTS, 4 underloaded and 6 overloaded. No differences in PROMs were found based on loading asymmetry. Beyond the early phase of rehabilitation from ACLR, individual-level analyses are required to reveal differing loading strategies during bilateral squats.
在 ACLR 后进行双侧深蹲时，对动力学不对称性的研究仅限于主要的横断面研究和在特定膝关节角度提取的离散值数据。我们使用曲线分析在康复过程中纵向评估深蹲时的负荷不对称性，并比较了有和无不对称性的患者报告的结果测量（PROM）。24 名个体（13 名女性）在 ACLR 后分三次进行体重深蹲：（1）早期 2.9（1.1）个月；（2）中期 8.8（3.1）个月；（3）重返运动（RTS）13.1（3.6）个月；29 名无症状对照者（22 名女性）仅一次。使用功能数据分析方法比较矢状面髋关节、膝关节和踝关节力矩以及垂直地面反作用力的双侧腿间时间归一化不对称曲线。当 ACLR 在≥50%的深蹲期间超过对照的 95%置信区间时，将其分类为个体不对称加载。在早期，与对照组相比，ACL 在膝关节（15%-100%离心阶段；0%-100%向心）和踝关节屈曲力矩（56%-65%向心）方面的不对称性更大。在中期，ACL 在膝关节（41%-72%离心）和踝关节屈曲力矩（56%-69%向心）方面的不对称性更大。在 RTS 时，两组之间没有差异。从早期到 RTS，ACL 在髋关节（21%-46%离心）、膝关节（27%-58%向心）和踝关节屈曲力矩（21%-57%离心）方面减少了不对称性。在早期，24 名患者中有 11 名对 ACLR 膝关节的负荷不足，1 名负荷过重，与对照组相比。在 RTS 时，有 4 名负荷不足，6 名负荷过重。根据负荷不对称性，未发现 PROM 存在差异。在 ACLR 康复的早期阶段之后，需要进行个体水平的分析，以揭示双侧深蹲时不同的加载策略。
