男性前交叉韧带重建术后早期神经肌肉及共激活模式：一项病例对照探索性可行性研究
简介
本研究纳入15例男性前交叉韧带重建术后（腘绳肌腱自体移植物）患者（术后15.3±0.7天）及15例健康对照，通过表面肌电图评估最大等长收缩时股外侧肌、股内侧肌、股二头肌及内侧腘绳肌的激活程度，并计算共激活指数。关键发现：ACLR组患侧股外侧肌和股内侧肌激活显著低于对照组（p<0.001），股二头肌激活也较低（p=0.011）；所有四组肌群的共激活指数均显著高…
英文摘要
BACKGROUND: Arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR) is a major barrier to muscle recovery, but early (within the first ~2 weeks after surgery) neuromuscular profiles remain poorly quantified. Excessive hamstring co-activation, a common compensatory response to quadriceps inhibition, may further compromise knee mechanics and rehabilitation outcomes. Hypothesis/Purpose: The primary objective of this study was to compare early quadriceps activation and quadriceps/hamstring co-activation patterns between individuals following ACLR and matched healthy controls (CTRL). The secondary objective was to determine whether these neuromuscular alterations were present bilaterally, affecting both the operated and non-operated limbs. It was hypothesized that individuals post-ACLR would demonstrate reduced voluntary quadriceps activation and increased hamstring co-activation compared to CTRL, as well as bilateral neuromuscular alterations within the ACLR group. STUDY DESIGN: Cross-sectional case-control study. METHODS: Thirty males (15 primary unilateral ACLR with hamstring autograft, 15 healthy controls) were assessed 15.3 ± 0.7 days after ACLR (pre-injury Tegner Activity Scale: 7 ± 1). Inclusion criteria required a Stroke Test score < 1+ and no passive extension deficit, defined by SANTI (Scientific Anterior Cruciate Ligament Network International) classification of AMI type 1-2. Participants performed three 5-second maximal voluntary isometric knee extensions (MVIC) in supine position with the knee fully extended; no sEMG normalization was performed, and raw RMS values were used for analysis. Surface electromyography (sEMG) was recorded from vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), and medial hamstrings (MH) at 1000 Hz; mean Root Mean Square (RMS) values were then computed over a 3-s stable plateau window of each MVIC and used for analysis. Co-activation Indices (CoI) were calculated for the agonist-antagonist pairs VL-BF, VM-BF, VL-MH, and VM-MH. ACLR group versus CTRL was via independent-samples t-tests, and intra-individual ACLR group comparisons (operated vs. non operated limb) via paired-samples t-tests. Effect sizes (Hedges' g for between-group, Cohen's d for paired comparisons; rank-biserial correlation for non-parametric tests) were reported with 95% confidence intervals. RESULTS: Significantly lower mean values were found in the operated limb of the ACLR group compared to CTRL for VL (4.15 ± 2.24 vs 7.89 ± 1.50 μV, p < 0.001), VM (4.07 ± 2.25 vs 9.07 ± 1.24 μV, p < 0.001), and BF (3.73 ± 2.64 vs 5.79 ± 3.56 μV, p = 0.011). In the operated limb, all CoI were significantly higher (all p < 0.001) in the ACLR group than in CTRL for VL-BF (47.77 ± 9.92% vs 32.07 ± 9.32%), VM-BF (48.83 ± 8.98% vs 29.10 ± 5.45%), VL-MH (49.83 ± 11.58% vs 31.08 ± 6.78%), and VM-MH (48.17 ± 9.38% vs 29.11 ± 5.69%). Intra-individual and contralateral comparisons showed that the ACLR group presented with significantly higher CoI in the non-operated limb compared to CTRL for VL-MH (36.1 ± 5.1% vs 29.9 ± 6.0%, p = 0.018) and VM-MH (35.7 ± 5.9% vs 28.4 ± 4.9%, p < 0.001). No significant between-group differences were found for MH activation (p = 0.250). CONCLUSION: Within the first 15.3 ± 0.7 days after ACLR, subjects who had undergone ACLR showed markedly reduced voluntary quadriceps activation associated with increased, bilateral hamstring co-activation, in both the operated and non-operated limb. LEVEL OF EVIDENCE: Level 3, cross-sectional case-control study.