Department of Biomechanics, Faculty of Physical Therapy, October 6 University, Egypt.
Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt.
Gait Posture. 2024 Sep;113:512-518. doi: 10.1016/j.gaitpost.2024.08.011. Epub 2024 Aug 15.
Anterior cruciate ligament (ACL) rehabilitation is a common intervention after ACL reconstruction. Since different types of exercise can influence muscle and kinematic parameters in diverse ways, the training order between the knee and ankle joints may also change gait parameters.
This study aimed to investigate whether the training sequence of the knee and ankle joints (knee followed by ankle training or vice-versa) in an ACL reconstruction (ACLR) rehabilitation program has any effects on knee extension and flexion torques.
Forty-two men (aged 20-30 years) with ACLR participated in this study. They were randomly allocated to receive one of two interventions: (A) knee joint training followed by ankle training or (B) ankle joint training followed by knee training. After five weeks (four weeks of intervention and one-week washout), participants crossed from one group to another for an additional four weeks. Knee extension and flexion torques were assessed during the stance phase of the gait cycle before and after the intervention program.
Two-way Mixed-design MANOVA showed that knee extension torque improved significantly in both groups after training (p = 0.001, Cohen's D = 0.65), while the knee flexion torque increased significantly only in group B (p= 0.001, Cohen's D = 0.97). When comparing both groups, patients of group B presented significant improvements in the post-training mean values of all tested variables compared with group A.
Starting a post-ACLR rehabilitation program with ankle training followed by knee training is better to improve knee flexion and extension torques during the stance phase of the gait cycle than starting the program by training the knee first, followed by the ankle. Future studies using a mixed-gender sample and different types of ACLR operations are necessary to examine whether similar improvements will happen as well as to test their effects on many sports activities.
前交叉韧带（ACL）康复是 ACL 重建后的常见干预措施。由于不同类型的运动可以以不同的方式影响肌肉和运动学参数，因此膝关节和踝关节的训练顺序也可能改变步态参数。
本研究旨在探讨 ACL 重建（ACLR）康复计划中膝关节和踝关节的训练顺序（先膝关节后踝关节训练或反之）是否对膝关节伸屈扭矩有影响。
42 名 20-30 岁男性 ACLR 患者参与了本研究。他们被随机分配接受两种干预措施之一：（A）膝关节训练后进行踝关节训练，或（B）踝关节训练后进行膝关节训练。五周后（四周干预和一周洗脱期），参与者从一组交叉到另一组，再进行四周。在干预计划前后，评估步态周期支撑相期间的膝关节伸屈扭矩。
双向混合设计 MANOVA 显示，两组训练后膝关节伸肌扭矩均显著改善（p=0.001，Cohen's D=0.65），而仅在 B 组膝关节屈肌扭矩显著增加（p=0.001，Cohen's D=0.97）。比较两组时，B 组患者在所有测试变量的后训练平均值方面均显著优于 A 组。
在开始 ACLR 后康复计划时，先进行踝关节训练，然后进行膝关节训练，比先进行膝关节训练，然后进行踝关节训练，更有利于改善步态周期支撑相期间的膝关节伸屈扭矩。未来需要使用混合性别样本和不同类型的 ACLR 手术来研究是否会产生类似的改善，并测试它们对许多运动活动的影响。
