前交叉韧带重建患者双腿垂直跳跃期间的下肢生物力学特征

Biomechanical characteristics of the lower limbs of athletes after anterior cruciate ligament reconstruction during bilateral vertical jumping

背景:目前常采用术后时间或临床医生主观标准来确定前交叉韧带重建后患者重返运动时机,但这些标准没有充分考虑到前交叉韧带重建后患者的下肢生物力学缺陷。目的:探究前交叉韧带重建后患者双腿垂直跳跃期间的下肢运动学与动力学特征。方法:于2021年12月至2022年12月在武汉体育学院招募前交叉韧带重建后运动员与健康运动员各20名,年龄20-24岁,40名受试者进行双腿垂直跳跃试验,采集双腿垂直跳跃起跳阶段、初始着地时刻和垂直地面反作用力峰值时刻的运动学、动力学特征。结果与结论:①初始着地时刻,与健康对照组相比,前交叉韧带重建组受试者术侧显示出更高的髋关节屈曲角度及更低的踝关节跖屈角度(P=0.013,P=0.018);②垂直地面反作用力峰值时刻,与健康对照组相比,前交叉韧带重建组受试者术侧表现出更高的髋关节屈曲角度、膝关节外旋角度及踝关节外旋角度(P=0.016,P=0.030,P=0.042),更低的髋关节外展角度及膝关节屈曲角度(P=0.019,P=0.025);③垂直地面反作用力峰值时刻,与健康对照组相比,前交叉韧带重建组受试者术侧显示出更低的膝关节伸展力矩、膝关节内旋力矩及髋关节外展力矩(P=0.036,P=0.016,P=0.004),术侧表现出更高的髋关节伸展力矩及髋关节外旋力矩(P=0.040,P=0.005);④结果说明,前交叉韧带重建后患者表现出僵硬的着陆模式,倾向于将术侧膝关节负荷转移至髋关节,并显示出下肢旋转稳定性控制不足,因此检测和纠正异常生物力学特征应该成为前交叉韧带重建术后康复的一部分。

BACKGROUND:At present,postoperative timing or subjective criteria by clinicians are commonly employed to determine the return-to-sport timing for patients undergoing anterior cruciate ligament reconstruction.Unfortunately,these criteria do not adequately consider the biomechanical deficits in patients following anterior cruciate ligament reconstruction.OBJECTIVE:To explore the lower extremity kinematic and kinetic characteristics of athletes after anterior cruciate ligament reconstruction during bilateral vertical jumping.METHODS:Twenty athletes undergoing anterior cruciate ligament reconstruction and twenty healthy athletes,aged 20-24 years,were recruited in Wuhan Sports University from December 2021 to December 2022.All the 40 subjects underwent a bilateral vertical jumping test.The kinematic and dynamic characteristics of the lower limbs at propulsion phase,initial landing time and peak vertical ground reaction force moment.RESULTS AND CONCLUSION:At the initial landing time,the athletes undergoing anterior cruciate ligament reconstruction showed higher hip flexion angle(P=0.031)and lower ankle plantar flexion angle(P=0.018)on the operated side compared with the healthy athletes.At the peak vertical ground reaction force moment,the athletes undergoing anterior cruciate ligament reconstruction had higher hip flexion angle(P=0.016),lower hip abduction angle(P=0.019),lower knee flexion angle(P=0.025),higher knee external rotation angle(P=0.030),and higher ankle external rotation angle(P=0.042)on the operated side compared with the healthy athletes.At the peak vertical ground reaction force moment,the athletes undergoing anterior cruciate ligament reconstruction showed lower knee extension moment(P=0.036),lower knee internal rotation moment(P=0.016),lower hip abduction moment(P=0.004),higher hip extension moment(P=0.040),and higher hip external rotation moment(P=0.005)on the operated side compared with the healthy athletes.To conclude,the athletes undergoing anterior cruciate ligament reconstruction exhibit a stiff landing pattern,in which the knee load on the operated side tends to shift to the hip joint,and show inadequate control of lower limb rotational stability.Therefore,detection and correction of abnormal biomechanical characteristics should be part of the rehabilitation after anterior cruciate ligament reconstruction.