关节镜下半月板部分切除术后变向动作中倒数第二步和最后一步的运动策略
简介
本研究对24例关节镜下半月板部分切除术（APM）后患者与20例健康对照者进行90°变向动作的生物力学分析，发现术后患肢在制动期以踝关节代偿为主，推进期以髋关节代偿为主，且患肢制动负荷会转移至对侧肢体。提示康复训练除重视膝关节功能恢复外，还需关注踝、髋关节对再分配负荷的适应能力。
英文摘要
Persistent knee offloading is well-documented after arthroscopic partial meniscectomy (APM). Yet, it remains unclear if this extends to higher-demanding change-of-direction (CoD) tasks and how step-specific strategies influence joint loading. We aimed to compare joint power and relative contributions in the surgical limb, contralateral limb, and healthy individuals during a 90° CoD. A secondary aim examined the relationship between knee negative power at the penultimate and final foot contacts across limb sequences. Kinematic and kinetic data were collected from 24 post-APM and 20 healthy individuals using motion capture with force plates. Participants performed a running approach before executing a 90° CoD. Linear mixed-effects models compared limb differences and examined the relationship between steps. During penultimate contact, APM limb showed lower magnitudes of total (mean difference 2.80 W/kg, 95% CI 0.59, 5.00) and knee (2.60 W/kg, 0.75, 4.46) negative power than healthy limbs, with lower knee (-10.57%, -19.63, -1.52) and higher ankle (10.13%, 0.47, 19.79) contributions. During final contact, APM limb showed lower magnitudes of knee negative power (0.65 W/kg, 0.06, 1.24) than contralateral limbs. Compared with healthy, APM limb showed lower positive knee and ankle power, with lower knee (-7.23%, -14.19, -0.27) and greater hip (9.73%, 0.33, 19.13) contributions. Persistent knee deficits occurred post-APM, characterized by ankle-dominant braking and hip-dominant propulsion. Limb sequence influenced knee loading, with APM penultimate contact shifting braking to the contralateral limb at final contact. These findings suggest rehabilitation approaches may benefit from prioritizing knee function while preparing the ankle and hip to tolerate redistributed loads.