ACL损伤后功能缺陷与神经肌肉控制改变相关：一项横断面研究
简介
横断面研究对比114例单侧ACL断裂患者（急性55例、慢性59例）与57名对照，用等长、等速肌力测试及表面肌电评估肌力和拮抗肌共激活。患侧伸膝力矩急性期最低、慢性期仍低于对照；腘绳肌共激活以慢性组最高，且与KOOS各亚量表负相关。提示ACL损伤后神经肌肉控制异常随病程呈不同模式。
英文摘要
OBJECTIVES: Persistent muscle weakness after anterior cruciate ligament (ACL) injury may coexist with altered antagonist coactivation, but how these neuromuscular deficits differ according to injury chronicity and relate to patient-reported knee function remains incompletely characterized. This study aimed to compare knee muscle strength and antagonist coactivation among acute and chronic ACL injury groups, and healthy controls, and to evaluate the associations among muscle strength, antagonist coactivation, and Knee injury and Osteoarthritis Outcome Score (KOOS) subscale scores. METHODS: This study included 114 patients with unilateral isolated ACL rupture [55 acute (<6 weeks) and 59 chronic (>6 months)] and 57 healthy controls. Maximal voluntary isometric contraction and concentric isokinetic knee extension and flexion at 60°/s were assessed. Surface electromyography quantified hamstring and quadriceps antagonist coactivation. KOOS subscales were collected in the ACL-injured groups. Group and sex comparisons, Spearman correlations, and multiple linear regression analyses were performed. Study design: Cross-sectional study; Level of Evidence: III. RESULTS: Affected-limb extension peak torque was lowest in the acute group and remained lower in the chronic group than in controls for both male participants (2.23 ± 0.64, 3.05 ± 0.60, and 3.48 ± 0.59 N⋅m⋅kg-1, respectively) and female participants (1.51 ± 0.58, 2.21 ± 0.61, and 3.05 ± 0.56 N⋅m⋅kg-1; all P ≤ 0.001). Combined hamstring coactivation was greater in ACL-injured participants and highest in the chronic group (male: 14.32 ± 4.91%, 23.05 ± 5.87%, and 7.89 ± 4.34%; female: 27.18 ± 5.25%, 41.28 ± 6.34%, and 16.54 ± 5.28%; all P < 0.001). Extension average peak torque correlated positively with all KOOS subscales (r = 0.381-0.562), whereas combined hamstring coactivation correlated negatively with all KOOS subscales (r = -0.326 to -0.541; P < 0.05). CONCLUSION: ACL injury was associated with lower knee strength and greater antagonist coactivation, with distinct patterns according to injury chronicity. Strength deficits were most pronounced in patients with acute ACL injury, whereas antagonist coactivation was generally greatest in patients with chronic ACL injury. Greater hamstring coactivation and lower knee extension torque were associated with worse patient-reported knee function.