{"title":"前交叉韧带重建后步态速度的增加改变了膝关节力学：跑步机训练在早期康复中的意义和注意事项。","authors":"Sara Y Almansouri, Susan M Sigward","doi":"10.26603/001c.129803","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Current rehabilitation practices following anterior cruciate ligament reconstruction (ACLr) do not guarantee recovery of gait mechanics suggesting that gait specific interventions are needed. Increasing gait speed implicitly increases lower extremity demands; however, it is not known if increased treadmill speed will result in improved knee mechanics in early recovery post-ACLr. Therefore, the purpose of this study was to determine how individuals four months post-ACLr respond to the demands of increased speed during treadmill gait.</p><p><strong>Study design: </strong>Cross-sectional.</p><p><strong>Methods: </strong>Ten individuals 109.2±19.9 days post-ACLr and twelve uninjured individuals participated. Participants walked on a treadmill at self-selected (SS), 25% faster (SS25) and 50% faster (SS50) speeds. Kinematic and kinetic data were used to calculate net joint moments using standard inverse dynamic equations. Knee power was calculated as the scalar product of angular velocity and sagittal plane net joint moment. Knee flexion excursion was calculated from initial contact to the subsequent knee flexion peak. A 3 X 2 ANOVA assessed the effect of group and speed (SS, SS25, SS50) on surgical (or control) knee extensor moment, power absorption, knee excursion, GRFs and between limb symmetry.</p><p><strong>Results: </strong>For controls, knee extensor moment, power absorption, excursion, and GRFs increased at each speed. For ACLr, knee loading variables increased between SS to SS25 without changes in limb symmetry. No further increase in knee moments were observed between SS25 and SS50, but limb symmetry decreased in extensor moment, power, and GRFs.</p><p><strong>Conclusion: </strong>At four months post-ACLr, a moderate increase in treadmill speed may provide a stimulus to improve knee loading without increased asymmetries. Larger increases in speed should be exercised with caution to avoid undesirable between limb compensations. A progressive increase in demand to improve knee loading deficits during early recovery of ACLr is warranted.</p><p><strong>Level of evidence: </strong>2.</p>","PeriodicalId":47892,"journal":{"name":"International Journal of Sports Physical Therapy","volume":"20 3","pages":"354-363"},"PeriodicalIF":1.6000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872559/pdf/","citationCount":"0","resultStr":"{\"title\":\"Increased Gait Speed Changes Knee Mechanics Following Anterior Cruciate Ligament Reconstruction: Implications and Caution for Treadmill Training in Early Rehabilitation.\",\"authors\":\"Sara Y Almansouri, Susan M Sigward\",\"doi\":\"10.26603/001c.129803\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Current rehabilitation practices following anterior cruciate ligament reconstruction (ACLr) do not guarantee recovery of gait mechanics suggesting that gait specific interventions are needed. Increasing gait speed implicitly increases lower extremity demands; however, it is not known if increased treadmill speed will result in improved knee mechanics in early recovery post-ACLr. Therefore, the purpose of this study was to determine how individuals four months post-ACLr respond to the demands of increased speed during treadmill gait.</p><p><strong>Study design: </strong>Cross-sectional.</p><p><strong>Methods: </strong>Ten individuals 109.2±19.9 days post-ACLr and twelve uninjured individuals participated. Participants walked on a treadmill at self-selected (SS), 25% faster (SS25) and 50% faster (SS50) speeds. Kinematic and kinetic data were used to calculate net joint moments using standard inverse dynamic equations. Knee power was calculated as the scalar product of angular velocity and sagittal plane net joint moment. Knee flexion excursion was calculated from initial contact to the subsequent knee flexion peak. A 3 X 2 ANOVA assessed the effect of group and speed (SS, SS25, SS50) on surgical (or control) knee extensor moment, power absorption, knee excursion, GRFs and between limb symmetry.</p><p><strong>Results: </strong>For controls, knee extensor moment, power absorption, excursion, and GRFs increased at each speed. For ACLr, knee loading variables increased between SS to SS25 without changes in limb symmetry. No further increase in knee moments were observed between SS25 and SS50, but limb symmetry decreased in extensor moment, power, and GRFs.</p><p><strong>Conclusion: </strong>At four months post-ACLr, a moderate increase in treadmill speed may provide a stimulus to improve knee loading without increased asymmetries. Larger increases in speed should be exercised with caution to avoid undesirable between limb compensations. A progressive increase in demand to improve knee loading deficits during early recovery of ACLr is warranted.</p><p><strong>Level of evidence: </strong>2.</p>\",\"PeriodicalId\":47892,\"journal\":{\"name\":\"International Journal of Sports Physical Therapy\",\"volume\":\"20 3\",\"pages\":\"354-363\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872559/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Sports Physical Therapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.26603/001c.129803\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"SPORT SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Sports Physical Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.26603/001c.129803","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"SPORT SCIENCES","Score":null,"Total":0}
引用次数: 0
摘要
背景：目前的前交叉韧带重建（ACLr）后的康复实践并不能保证步态力学的恢复，这表明需要对步态进行特定的干预。增加步态速度隐含地增加下肢需求；然而，尚不清楚跑步机速度的增加是否会改善aclr术后早期恢复的膝关节力学。因此，本研究的目的是确定aclr后4个月个体对跑步机步态中速度增加的需求的反应。研究设计：横断面。方法：术后109.2±19.9 d 10只，未损伤12只。参与者在跑步机上以自己选择的速度（SS）、25%的速度（SS25）和50%的速度（SS50）行走。利用运动学和动力学数据，利用标准逆动力学方程计算净关节力矩。膝关节功率计算为角速度与矢状面关节力矩的标量积。从初始接触到随后的膝关节屈曲峰值，计算膝关节屈曲偏移。3 × 2方差分析评估组和速度（SS、SS25、SS50）对手术（或对照）膝关节伸肌力矩、力量吸收、膝关节偏移、GRFs和肢间对称的影响。结果：对于对照组，膝关节伸肌力矩、能量吸收、偏移和GRFs随速度的增加而增加。对于ACLr，从SS到SS25，膝关节负荷变量增加，但肢体对称性没有改变。在SS25和SS50之间没有观察到膝关节力矩进一步增加，但肢体对称性在伸肌力矩、力量和GRFs方面有所下降。结论：在aclr后4个月，适度增加跑步机速度可以刺激改善膝关节负荷而不增加不对称性。较大的速度增加应谨慎操作，以避免不必要的肢体间补偿。在ACLr早期恢复期间，改善膝关节负荷缺陷的需求逐渐增加是有保证的。证据等级：2。
Increased Gait Speed Changes Knee Mechanics Following Anterior Cruciate Ligament Reconstruction: Implications and Caution for Treadmill Training in Early Rehabilitation.
Background: Current rehabilitation practices following anterior cruciate ligament reconstruction (ACLr) do not guarantee recovery of gait mechanics suggesting that gait specific interventions are needed. Increasing gait speed implicitly increases lower extremity demands; however, it is not known if increased treadmill speed will result in improved knee mechanics in early recovery post-ACLr. Therefore, the purpose of this study was to determine how individuals four months post-ACLr respond to the demands of increased speed during treadmill gait.
Study design: Cross-sectional.
Methods: Ten individuals 109.2±19.9 days post-ACLr and twelve uninjured individuals participated. Participants walked on a treadmill at self-selected (SS), 25% faster (SS25) and 50% faster (SS50) speeds. Kinematic and kinetic data were used to calculate net joint moments using standard inverse dynamic equations. Knee power was calculated as the scalar product of angular velocity and sagittal plane net joint moment. Knee flexion excursion was calculated from initial contact to the subsequent knee flexion peak. A 3 X 2 ANOVA assessed the effect of group and speed (SS, SS25, SS50) on surgical (or control) knee extensor moment, power absorption, knee excursion, GRFs and between limb symmetry.
Results: For controls, knee extensor moment, power absorption, excursion, and GRFs increased at each speed. For ACLr, knee loading variables increased between SS to SS25 without changes in limb symmetry. No further increase in knee moments were observed between SS25 and SS50, but limb symmetry decreased in extensor moment, power, and GRFs.
Conclusion: At four months post-ACLr, a moderate increase in treadmill speed may provide a stimulus to improve knee loading without increased asymmetries. Larger increases in speed should be exercised with caution to avoid undesirable between limb compensations. A progressive increase in demand to improve knee loading deficits during early recovery of ACLr is warranted.
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