Dürselen L, Claes L, Kiefer H
Department of Orthopaedic Research and Biomechanics, University of Ulm, Germany.
Am J Sports Med. 1995 Jan-Feb;23(1):129-36. doi: 10.1177/036354659502300122.
We know it is important to avoid excessive strain on reconstructed ligaments, but we do not know how individual muscles affect cruciate ligament strain. To answer this, we studied the effect of muscle forces and external loads on cruciate ligament strain. Nine cadaveric knee joints were tested in an apparatus that allowed unconstrained knee joint motion. Quadriceps, hamstring, and gastrocnemius muscle forces were simulated. Additionally, external loads were applied such as varus-internal or valgus-external rotation forces. Cruciate ligament strain was recorded at different knee flexion angles. Activation of the gastrocnemius muscle significantly (P < 0.05) strained the posterior cruciate ligament at flexion angles larger than 40 degrees. Quadriceps muscle activation significantly strained the anterior cruciate ligament when the knee was flexed 20 degrees to 60 degrees (P < 0.01) and reduced the strain on the posterior cruciate ligament in the same flexion range (P < 0.05). Activation of the hamstring muscles strained the posterior cruciate ligament when the knee was flexed 70 degrees to 110 degrees (P < 0.05). Combined varus and internal rotation forces significantly increased anterior cruciate ligament strain throughout the flexion range (P < 0.05). The results suggest that to minimize strain on the ligament after posterior cruciate ligament surgery, strong gastrocnemius muscle contractions should be avoided beyond 30 degrees of knee flexion. The study also calls into question the use of vigorous quadriceps exercises in the range of 20 degrees to 60 degrees of knee flexion after anterior cruciate ligament reconstruction.
我们知道避免重建韧带承受过大压力很重要，但我们不知道个体肌肉如何影响交叉韧带的压力。为了回答这个问题，我们研究了肌肉力量和外部负荷对交叉韧带压力的影响。在一个允许膝关节无约束运动的装置中对九个尸体膝关节进行了测试。模拟了股四头肌、腘绳肌和腓肠肌的肌肉力量。此外，还施加了诸如内翻-内旋或外翻-外旋力等外部负荷。在不同的膝关节屈曲角度记录交叉韧带的压力。当膝关节屈曲角度大于40度时，腓肠肌的激活会显著（P < 0.05）使后交叉韧带产生压力。当膝关节屈曲20度至60度时，股四头肌的激活会显著使前交叉韧带产生压力（P < 0.01），并在相同的屈曲范围内降低后交叉韧带的压力（P < 0.05）。当膝关节屈曲70度至110度时，腘绳肌的激活会使后交叉韧带产生压力（P < 0.05）。内翻和内旋力的联合作用在整个屈曲范围内显著增加前交叉韧带的压力（P < 0.05）。结果表明，为了使后交叉韧带手术后韧带的压力最小化，在膝关节屈曲超过30度时应避免腓肠肌强烈收缩。该研究还对在前交叉韧带重建后膝关节屈曲20度至60度范围内进行剧烈股四头肌锻炼的做法提出了质疑。
