Objective To evaluate the effects of knee flexor and extensor strength on the subjective function and motor performance of knees after anterior cruciate ligament reconstruction. Methods A total of 53 patients who underwent anterior cruciate ligament reconstruction in the National Institute of Sports Medicine,General Administration of Sport of China from June 2015 to June 2021 and met the inclusion criteria were enrolled in this study.The patients were followed up time for at least 2 years.An isometric muscle strength test system was used to measure the strength of bilateral quadriceps and hamstring muscles.The patients were grouped according to whether the limb symmetry index (LSI) of peak torque of quadriceps and hamstring muscle reached 85% at an angular velocity of 60°/s.Specifically,26 patients were classified into group A (LSI≥85%) and 27 patients were classified into group B (LSI<85%).The subjective function and motor performance of knees were compared between the two groups. Results In terms of subjective function of knees,the international knee documentation committee (IKDC) score (88.76±9.93 vs. 81.08±12.57,P=0.017) and knee injury and osteoarthritis outcome score (KOOS) (86.27±8.96 vs. 80.22±11.31,P=0.036) were different between groups A and B.There was no significant difference in Lysholm score [95.0 (79.8,100.00) vs. 86.00 (66.00,100.00),P=0.238],ACL return to sports after injury scale score (66.08±22.25 vs. 61.12±23.53,P=0.434),Marx score [6.00 (4.75,7.00) vs. 6.00 (4.00,7.00),P=0.805] or Tegner activity score [8.00 (4.00,12.00) vs. 4.00 (2.00,12.00),P=0.566] between the two groups.In terms of motor performance,the single-leg triple hop LSI (0.92±0.13 vs. 0.81±0.18,P=0.016) and single-leg crossover hop LSI (0.96±0.12 vs. 0.84±0.22,P=0.021) showed significant differences between groups A and B,while there was no significant difference in single-leg hop LSI (0.90±0.18 vs. 0.79±0.25,P=0.116) between the two groups.In addition,there was no statistical significance in proprioception [30°:8.83±4.66 vs. 10.73±4.63,P=0.143;45°:6.94±3.82 vs. 7.66±3.93,P=0.504;60°:4.10 (3.20,4.72) vs. 3.90 (2.30,5.20),P=0.493] or Y-balance test results [anterior LSI:0.98 (0.84,1.02) vs. 0.94 (0.86,0.98),P=0.328;posterolateral LSI:1.00±0.08 vs. 0.97±0.07,P=0.249;posteromedial LSI:1.00 (0.97,1.03) vs. 0.96 (0.93,1.03),P=0.179] between groups A and B. Conclusion The patients with good symmetry of quadriceps and hamstring muscle strength after anterior cruciate ligament reconstruction had better subjective function and movement performance of knees than the patients with poor symmetry,which was mainly reflected in the IKDC score,KOOS,single-leg triple hop,and single-leg crossover hop.
目的 评估前交叉韧带重建术后膝关节屈伸肌群肌力对膝关节主观功能和运动表现的影响。方法 纳入2015年6月至2021年6月于国家体育总局体育医院行前交叉韧带重建术并且符合纳排标准的患者53例,术后随访时间至少2年。使用等速肌力测试系统对患者双侧股四头肌和腘绳肌肌力进行评估,根据角速度为60°/s时股四头肌和腘绳肌峰值力矩肢体对称指数(LSI)是否达到85%为分组依据对患者进行分组。其中,A组(患者股四头肌和腘绳肌峰值力矩LSI≥85%)26例,B组(患者股四头肌或腘绳肌峰值力矩LSI<85%)27例。比较两组患者膝关节主观功能和运动表现。结果 膝关节主观功能方面:A、B两组患者国际膝关节评分委员会评分[(88.76±9.93)分比(81.08±12.57)分,P=0.017]和膝关节损伤与骨关节炎评分[(86.27±8.96)分比(80.22±11.31)分,P=0.036]差异均有统计学意义;两组患者Lysholm[95.0(79.8,100.00) 分比 86.00(66.00,100.00)分,P=0.238]、前交叉韧带损伤后重返运动量表评分[(66.08±22.25)分比 (61.12±23.53)分,P=0.434]、Marx[6.00(4.75,7.00)分比6.00(4.00,7.00)分,P=0.805]和Tegner[8.00(4.00,12.00)分比4.00(2.00,12.00)分,P=0.566]差异均无统计学意义。运动表现方面:A、B两组患者单脚三级跳LSI(0.92±0.13 比0.81±0.18,P=0.016)和单脚交叉跳LSI(0.96±0.12 比0.84±0.22,P=0.021)差异均有统计学意义;A、B两组患者单脚跳LSI(0.90±0.18比 0.79±0.25,P=0.116)差异无统计学意义。A、B两组患者本体感觉差异[30°:8.83±4.66比10.73±4.63,P=0.143;45°:6.94±3.82 比7.66±3.93,P=0.504;60°:4.10(3.20,4.72)比 3.90(2.30,5.20),P=0.493]无统计学意义。A、B两组患者Y平衡测试[前向LSI:0.98(0.84,1.02)比0.94(0.86,0.98),P=0.328;后外侧向LSI:1.00±0.08比0.97±0.07,P=0.249;后内侧向LSI:1.00(0.97,1.03)比0.96(0.93,1.03),P=0.179]差异无统计学意义。结论 前交叉韧带重建术后股四头肌和腘绳肌肌力对称性良好的患者相比于对称性不佳的患者具有更好的膝关节主观功能和运动表现,主要体现在国际膝关节评分委员会评分、膝关节损伤与骨关节炎评分、单脚三级跳和单脚交叉跳4个方面。.
Keywords: anterior cruciate ligament; isokinetic muscle strength; motor performance; subjective function.