Yack H J, Riley L M, Whieldon T R
Physical Therapy Graduate Program, College of Medicine, University of Iowa, Iowa City 52242.
J Orthop Sports Phys Ther. 1994 Nov;20(5):247-53. doi: 10.2519/jospt.1994.20.5.247.
Many protocols for rehabilitating the knee following anterior cruciate ligament (ACL) injury or repair call for the use of both weight-bearing and nonweight-bearing exercises. However, not much is known about the strain these exercises place on the passive restraining mechanisms. The purpose of this study was to examine the effect of progressive loading of the knee extensors on anterior tibial translation during weight-bearing and nonweight-bearing isometric exercise. Fourteen subjects diagnosed as ACL-deficient via arthroscopic surgery participated in the study. An arthrometer was used to measure anterior tibial translation during weight-bearing and nonweight-bearing exercises with the knee in 20 degrees of flexion and with a quadriceps load equivalent to 25, 50, 75, and 100% of body weight. Hamstring muscle activations during all testing were monitored to eliminate the possibility of substantial cocontractions. During the weight-bearing exercise, anterior tibial translation was found to be significantly less than that measured during the Lachman's evaluation and the 50, 75, and 100% nonweight-bearing exercises. For the nonweight-bearing exercises, anterior tibial translation was either equivalent to or greater than the Lachman's evaluation. During the weight-bearing exercises, anterior tibial translation was not different under the different loading conditions. During the nonweight-bearing exercises, anterior tibial translation progressively increased with increased loading. The results from this study imply that weight-bearing exercises minimize strain to the passive restraining structures whereas nonweight-bearing exercises will strain these structures, and the magnitude of this strain appears to be proportional to the knee extensor moment.
许多前交叉韧带（ACL）损伤或修复后膝关节康复的方案都要求同时使用负重和非负重练习。然而，对于这些练习对被动约束机制所产生的应变了解并不多。本研究的目的是在负重和非负重等长运动期间，检查膝关节伸肌的渐进性负荷对胫骨前移的影响。14名经关节镜手术诊断为ACL缺陷的受试者参与了本研究。使用关节测量仪在膝关节屈曲20度且股四头肌负荷相当于体重的25%、50%、75%和100%的情况下，测量负重和非负重练习期间的胫骨前移。在所有测试过程中监测腘绳肌的激活情况，以消除明显协同收缩的可能性。在负重练习期间，发现胫骨前移明显小于Lachman评估以及50%、75%和100%非负重练习期间所测量的值。对于非负重练习，胫骨前移等于或大于Lachman评估。在负重练习期间，不同负荷条件下的胫骨前移没有差异。在非负重练习期间，胫骨前移随着负荷增加而逐渐增加。本研究结果表明，负重练习可使被动约束结构的应变最小化，而非负重练习会使这些结构产生应变，并且这种应变的大小似乎与膝关节伸肌力矩成正比。
