Xiao Jiaqi, Feng Chuanzhuang, Chu Jinxin, Zhao Wei, Zhang Bi, Yuan Xiangnan
Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, Chinax.
Shenyang Institute of Automation, Chinese Academy of Sciences, State Key Laboratory of Robotics and Intelligent Systems, Shenyang, Liaoning, Chinax.
BMJ Open. 2025 Sep 9;15(9):e093009. doi: 10.1136/bmjopen-2024-093009.
This study evaluated the effects of proximal core training on biomechanical risk factors and strength parameters in individuals at high risk of anterior cruciate ligament (ACL) injury (specifically: those exhibiting pathological movement patterns, neuromuscular deficits or biomechanical risk factors) and compared direct versus indirect interventions. We hypothesised that targeted training enhances dynamic knee stabilisation and hip control during high-risk manoeuvres, with direct approaches providing superior biomechanical benefits through neuromuscular control optimisation.
Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach.
We searched (PubMed, Web of Science, EBSCO Academic Search Premier (ASP)+Business Source Premier (BSP)) for relevant literature published between its inception and the date of retrieval (22 April 2024).
This study included studies comparing the effects of proximal core intensification training and lower extremity training, evaluated their influences on biomechanical risk factors and strength parameters in three types of high-risk ACL populations, and compared the direct and indirect intervention effects. The three types of people include: (1) athletes with pathological exercise patterns, (2) those with neuromuscular defects after ACL injury/reconstruction and (3) those without injury but with biomechanical risk factors.
Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. A meta-analysis was conducted using random effects models. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.
24 studies with a total of 749 participants were included. Meta-analyses demonstrated that proximal core strengthening training may increase lower extremity muscle strength (quadriceps peak torque: standardised mean differences (SMD)=0.65, 95% CI (0.29 to 1.01), I²=0%; hamstring peak torque: SMD=0.53, 95% CI (0.14 to 0.92), I²=0%; both p<0.05, low-quality evidence). For movement kinematics, task-dependent improvements were observed: peak knee flexion angle likely increased during jumping (SMD=0.58, 95% CI (0.20 to 0.96), I²=32%) and single-leg squatting (SMD=0.60, 95% CI (0.07 to 1.26), I²=0%) (both p≤0.05, low-quality evidence) but may have little meaningful effect during walking (low-quality evidence). Peak hip flexion may substantially increase during jumping (SMD=0.83, 95% CI (0.19 to 1.47), I²=0%, p<0.05, low-quality evidence), while core endurance may improve (plank time: SMD=0.63, 95% CI (0.12 to 1.13), I²=0%, p<0.05, low-quality evidence).
Proximal core training has the potential to improve core endurance, knee kinematics and lower limb strength in individuals at high risk of ACL injury, but evidence remains limited to late postoperative and exercise studies. Standardised protocols and harm rate validation are needed to confirm the preventive effectiveness of multidimensional protocols.
CRD42024532199.
本研究评估了近端核心训练对前交叉韧带（ACL）损伤高风险个体（具体为：表现出病理运动模式、神经肌肉功能缺陷或生物力学风险因素的个体）生物力学风险因素和力量参数的影响，并比较了直接干预与间接干预。我们假设针对性训练可增强高风险动作期间的动态膝关节稳定性和髋关节控制能力，且直接训练方法通过优化神经肌肉控制可带来更好的生物力学益处。
采用推荐分级、评估、制定与评价（GRADE）方法进行系统评价和荟萃分析。
我们检索了（PubMed、科学网、EBSCO学术搜索高级版（ASP）+商业资源高级版（BSP））自数据库建立至检索日期（2024年4月22日）期间发表的相关文献。
本研究纳入了比较近端核心强化训练与下肢训练效果的研究，评估了它们对三类ACL高风险人群生物力学风险因素和力量参数的影响，并比较了直接和间接干预效果。这三类人群包括：（1）具有病理运动模式的运动员，（2）ACL损伤/重建后存在神经肌肉缺陷的人群，（3）未受伤但具有生物力学风险因素的人群。
两名独立评审员使用标准化方法对纳入研究进行检索、筛选和编码。使用Cochrane协作网和证据项目工具评估偏倚风险。采用随机效应模型进行荟萃分析。研究结果在GRADE证据概况中进行总结并定性合成。
共纳入24项研究，总计749名参与者。荟萃分析表明，近端核心强化训练可能会增加下肢肌肉力量（股四头肌峰值扭矩：标准化均数差（SMD）=0.65，95%置信区间（CI）（0.29至1.01），I²=0%；腘绳肌峰值扭矩：SMD=0.53，95%CI（0.14至0.92），I²=0%；p均<0.05，低质量证据）。对于运动学，观察到任务相关的改善：跳跃（SMD=0.58，95%CI（0.20至0.96），I²=32%）和单腿深蹲（SMD=0.60，95%CI（0.07至1.26），I²=0%）时膝关节屈曲峰值角度可能增加（p均≤0.05，低质量证据），但在行走时可能影响不大（低质量证据）。跳跃时髋关节屈曲峰值可能大幅增加（SMD=0.83，95%CI（0.19至1.47），I²=0%，p<0.05，低质量证据），同时核心耐力可能改善（平板支撑时间：SMD=0.63，95%CI（0.12至1.13），I²=0%，p<0.05，低质量证据）。
近端核心训练有可能改善ACL损伤高风险个体的核心耐力、膝关节运动学和下肢力量，但证据仍限于术后晚期和运动研究。需要标准化方案和伤害率验证来确认多维方案的预防效果。
PROSPERO注册号：CRD42024532199。
