八周视觉扰动训练对前交叉韧带重建术后男性运动员非预期变向下肢生物力学及失误的影响：一项随机对照临床试验
简介
一项随机对照试验纳入24名已重返运动的ACL重建男性运动员，分别接受标准视觉-认知神经肌肉训练或在此基础上增加频闪眼镜视觉扰动训练（每周3次，共8周）。结果显示，与标准训练相比，增加视觉扰动组在非预期切割动作中患侧膝外展力矩和地面反作用力显著降低，患侧膝关节屈曲活动度及双侧髋、膝关节屈曲角度改善更明显，且切割任务认知错误减少（-40.5% vs. -14.7…
英文摘要
BACKGROUND: Anterior cruciate ligament (ACL) tears are among the most common knee injuries, leading to joint instability, muscle weakness, and disrupted motor coordination. The neuromuscular consequences of ACL injury extend beyond the joint and surrounding musculature and also involve reorganization of the central nervous system. Current return-to-sport training protocols may not adequately restore subtle neuromuscular deficits associated with ACL injury neuroplasticity. Specifically, impaired neuromuscular control under visual or cognitive perturbations. These neuromuscular deficits are especially evident during unanticipated cutting maneuvers, which place high demands on rapid motor control and decision-making. METHODS: Twenty-four ACLR male athletes who had returned to sport were randomly assigned to a visual-cognitive neuromuscular training (VCNT) group (n = 12) or the VCNT with added visual perturbation via stroboscopic glasses (VCNT-S, n = 12). The primary outcome was lower-limb biomechanics during unanticipated cutting; secondary outcomes included cutting-task cognitive error. participants performed an unanticipated cutting maneuver (30-40°change of direction guided by two taped ground lines) in a biomechanics lab before and after an 8-week intervention (3 sessions/week). The outcome assessor was blinded to group allocation. RESULTS: All 24 participants (12 per group) were analyzed; no adverse events occurred. Compared with VCNT, VCNT-S showed greater reductions in involved knee abduction torque (mean difference: -0.08 Nm/kg, 95% CI: -0.14 to -0.02) and involved ground reaction force (mean difference: -0.39 BW, 95% CI: -0.55 to -0.23). VCNT-S also demonstrated greater improvements in involved knee flexion ROM (mean difference: +7.71°, 95% CI: 2.26° to 13.16°), uninvolved peak knee flexion (mean difference: +5.68°, 95% CI: 3.03° to 8.33°), and uninvolved peak hip flexion (mean difference: +7.64°, 95% CI: 3.50° to 11.78°), as well as greater reductions in involved knee abduction ROM (mean difference: -1.97°, 95% CI: -3.15° to -0.79°) and uninvolved peak knee abduction (mean difference: -2.85°, 95% CI: -5.52° to -0.18°). Cutting-task errors were reduced more in VCNT-S (-40.5% vs. -14.7%; mean difference: -25.8%, 95% CI: -47.2% to -4.4%; p = 0.02). CONCLUSION: Incorporating visual perturbation into neuromuscular training improved lower-limb biomechanics and reduced cognitive errors during unanticipated cutting compared to standard training. These surrogate outcomes suggest potential for modifying re-injury risk factors, through direct injury endpoints were not measured. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) at https://www.irct.ir/search/result?query=IRCT20250314065070N1, IRCT20250314065070N1, Date of Registration: 2025-06-03, (retrospective registration).