前交叉韧带重建术后步态速度增加对膝关节力学的影响：早期康复中跑步机训练的意义与注意事项
Increased Gait Speed Changes Knee Mechanics Following Anterior Cruciate Ligament Reconstruction: Implications and Caution for Treadmill Training in Early Rehabilitation.
作者信息
Almansouri Sara Y, Sigward Susan M
机构信息
Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences King Abdulaziz University.
Division of Biokinesiology and Physical Therapy University of Southern California.
出版信息
Int J Sports Phys Ther. 2025 Mar 1;20(3):354-363. doi: 10.26603/001c.129803. eCollection 2025.
BACKGROUND
Current rehabilitation practices following anterior cruciate ligament reconstruction (ACLr) do not guarantee recovery of gait mechanics suggesting that gait specific interventions are needed. Increasing gait speed implicitly increases lower extremity demands; however, it is not known if increased treadmill speed will result in improved knee mechanics in early recovery post-ACLr. Therefore, the purpose of this study was to determine how individuals four months post-ACLr respond to the demands of increased speed during treadmill gait.
STUDY DESIGN
Cross-sectional.
METHODS
Ten individuals 109.2±19.9 days post-ACLr and twelve uninjured individuals participated. Participants walked on a treadmill at self-selected (SS), 25% faster (SS25) and 50% faster (SS50) speeds. Kinematic and kinetic data were used to calculate net joint moments using standard inverse dynamic equations. Knee power was calculated as the scalar product of angular velocity and sagittal plane net joint moment. Knee flexion excursion was calculated from initial contact to the subsequent knee flexion peak. A 3 X 2 ANOVA assessed the effect of group and speed (SS, SS25, SS50) on surgical (or control) knee extensor moment, power absorption, knee excursion, GRFs and between limb symmetry.
RESULTS
For controls, knee extensor moment, power absorption, excursion, and GRFs increased at each speed. For ACLr, knee loading variables increased between SS to SS25 without changes in limb symmetry. No further increase in knee moments were observed between SS25 and SS50, but limb symmetry decreased in extensor moment, power, and GRFs.
CONCLUSION
At four months post-ACLr, a moderate increase in treadmill speed may provide a stimulus to improve knee loading without increased asymmetries. Larger increases in speed should be exercised with caution to avoid undesirable between limb compensations. A progressive increase in demand to improve knee loading deficits during early recovery of ACLr is warranted.
LEVEL OF EVIDENCE
背景
目前前交叉韧带重建（ACLr）后的康复训练方法并不能保证步态力学的恢复，这表明需要针对步态进行特定干预。增加步态速度会隐性增加下肢的负荷；然而，尚不清楚在ACLr术后早期恢复阶段，提高跑步机速度是否会改善膝关节力学。因此，本研究的目的是确定ACLr术后四个月的个体在跑步机步态中对速度增加的负荷有何反应。
研究设计
横断面研究。
方法
10名ACLr术后109.2±19.9天的个体和12名未受伤个体参与研究。参与者在跑步机上以自选速度（SS）、快25%（SS25）和快50%（SS50）的速度行走。运动学和动力学数据用于通过标准逆动力学方程计算净关节力矩。膝关节功率计算为角速度与矢状面净关节力矩的标量积。膝关节屈曲幅度从初始接触到随后的膝关节屈曲峰值进行计算。采用3×2方差分析评估组和速度（SS、SS25、SS50）对手术（或对照）侧膝关节伸肌力矩、功率吸收、膝关节幅度、地面反作用力（GRFs）以及双侧对称性的影响。
结果
对于对照组，在每个速度下膝关节伸肌力矩、功率吸收、幅度和GRFs均增加。对于ACLr组，从SS到SS25膝关节负荷变量增加，且双侧对称性无变化。在SS25和SS50之间未观察到膝关节力矩进一步增加，但在伸肌力矩、功率和GRFs方面双侧对称性下降。
结论
在ACLr术后四个月，适度提高跑步机速度可能有助于改善膝关节负荷，且不会增加不对称性。更大幅度的速度增加应谨慎进行，以避免出现不良的双侧代偿。在ACLr术后早期恢复阶段，逐步增加负荷以改善膝关节负荷不足是有必要的。
证据水平
2级。
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