Changes in the flexion and extension muscle strength and motor function of the knee joint after anterior cruciate ligament reconstruction

doi:10.3969/j.issn.2095-4344.0279

Abstract

Abstract:

BACKGROUND: Although the effect of anterior cruciate ligament (ACL) reconstruction is good, the postoperative muscle strength is still absent and the motor function cannot be fully recovered.

OBJECTIVE: To observe the muscle strength and functional performance of the affected limbs after ACL reconstruction using semitendonosus and gracilis as a autograft, so as to guide the rehabilitation of patients with ACL reconstruction.

METHODS: Totally 150 patients with ACL injuries participated in this study. All patients underwent ACL reconstruction using semitendonosus and gracilis as an autograft and rehabilitation. Extension and flexion torques were measured for the injured and healthy limbs at postoperative 3, 6, 9 and 12 months, and the quadriceps strength symmetry index, hamstring/quadriceps ratio were measured. The single hop test, the 6-m timed hop test, crossover hop test and the side-to-side hop test were conducted at 6 and 12 months postoperatively. The changes of muscle strength and motor function with time were analyzed and evaluated.

RESULTS AND CONCLUSION: (1) Of the 150 patients, only 118 patients completed all tests, and 32 patients (21.3 %) lost to follow up. (2) The average quadriceps strength of the affected side at 3, 6, 9, and 12 months postoperatively was (64.01±4.45)%, (77.97±5.04)%, (84.25±5.14)% and (86.98±5.28)% of the healthy side, respectively. The average hamstring strength of the affected side at 3, 6, 9, and 12 months postoperatively was (81.58±3.12)%, (91.06±3.72)%, (96.48±3.87)% and (97.59±3.77)% of the healthy side, respectively. Repeated measurement test confirmed that the flexor/extensor strength gradually recovered with time (F=27.23, P=0.00). (3) Muscle strength recovered quickly between 3 and 6 months (P < 0.05). The quadriceps strength of involved limb was still significantly lower than the uninvolved limb after 12 months (P < 0.05). The hamstring muscle was not significantly different from the uninvolved limb after 12 months (P > 0.05). (4) At 3, 6, 9 and 12 months postoperatively, hamstring/quadriceps ratios were significantly higher than the healthy limb (P < 0.05). (5) At 6 months postoperatively, results of the single hop test, crossover hop test, the side-to-side hop test and the 6-m timed hop test were lower than 90% of the healthy limb. At 12 months postoperatively, results of the single hop test and the 6-m timed hop test were higher than 90% of the healthy limb, but crossover hop test and the side-to-side hop test were still lower than 90% of the healthy limb. (6) These results manifest that the best period for the restoration of flexion and extension strength is 3-6 months postoperatively. The extensor muscle strength, hamstring/ quadriceps strength ratios and sport ability of the patients are not completely restored to normal at 12 months postoperatively.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Anterior Cruciate Ligament, Knee, Rehabilitation, Tissue Engineering

CLC Number:

R318

Liu Zhi-cheng, Li Yan, Zhang Qi-liang. Changes in the flexion and extension muscle strength and motor function of the knee joint after anterior cruciate ligament reconstruction [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(27): 4393-4399.

Figures/Tables 2

2.1 参与者数量分析纳入随访研究对象150例，研究对象中只有118例完成全部测试，32例由于各种原因失访，失访率21.33%，见图5。 2.2 患者一般情况根据纳入标准共150例患者进入随访研究，由于各种原因造成失访32例。118例患者完成随访，其中男性78例，女性40例，年龄(25.66±5.18)岁，体质量指数 (24.16±3.28) kg/m2。右膝68例，左膝50例；损伤原因：交通伤48例，运动伤70例。 2.3 双侧膝关节屈肌及伸肌肌力情况双侧肢体屈、伸肌力的等速测试结果见表1。单因素重复测量结果显示：重建后不同时间，患肢伸肌的肌力有显著差异，随时间延长，肌力逐渐恢复(F=89.63，P=0.00)；采用Bonferroni检验两两比较证实，重建后3-6个月期间、6-9个月期间，肌力均有显著改变，其中3-6个月期间肌力恢复更快(P3-6=0.00， P-9=0.001)；重建后9-12期间肌力改变不显著(P9-12=0.22)。重建后不同时间，患肢屈肌的肌力有显著差异，随时间延长，肌力逐渐恢复(F=27.23，P=0.00)；采用Bonferroni检验两两比较证实，重建后3-6个月期间屈肌肌力有显著改变(P3-6=0.00)，重建后6-9个月期间、重建后9-12期间肌力改变不显著(P6-9=0.10，P9-12=0.18)。重建后不同时间，健侧屈肌、伸肌肌力均无显著差异(F=0.76，P=0.52；F=0.37，P=0.77)。双因素重复测量结果证实，患侧肢体的屈、伸肌力与健侧肢体比较，有显著性差异(F=47.66，P=0.00；F=932.70，P=0.00)；采用多变量方差分析对每个时间点上患侧与健侧屈、伸肌力的比较结果证实，患侧伸肌肌力在重建后3，6，9，12个月时均显著低于健侧伸肌肌力(F=520.67，P=0.00；F=217.75，P=0.00；F=99.46，P=0.00；F=67.87，P=0.00) ；患侧屈肌肌力在重建后3，6个月时明显低于健侧屈肌肌力(F=68.76，P=0.00；F=12.82，P=0.00)，患侧屈肌肌力在9，12个月时与健侧相比无显著差异(F=1.77，P=0.18；F=1.176，P=0.28)。 2.4 双侧膝关节屈/伸肌肌力比值情况双侧膝关节屈/伸肌力比值见表2，经单因素重复测量结果证实，随重建后康复时间延长，患侧膝关节屈/伸肌肌力比值逐渐下降(F=46.80，P=0.00)，重建后3，6，9，12个月时健侧膝关节屈/伸肌肌力比值无显著差异(F=0.36，P=0.78)。双因素重复测量结果证实，患侧肢体的膝关节屈/伸肌肌力比值与健侧肢体比较，有显著性差异(F=528.23，P=0.00)，患侧膝关节屈/伸肌肌力比值显著高于健侧。采用多变量方差分析对每个时间点上膝关节屈/伸肌肌力比值的比较结果证实，患侧膝关节屈/伸肌肌力比值在重建后3，6，9，12个月时均显著高于健侧(F=316.08，P=0.00；F=177.93，P=0.00；F=100.24，P=0.00；F=119.78，P=0.00)。 2.5 患者下肢功能测试结果双侧单脚跳、6 m计时单脚跳、侧边单脚跳及交叉单脚跳等四项运动功能结果的对称指数见表3，重建后第6个月时单脚跳、6 m计时单脚跳、侧边单脚跳及交叉单脚跳运动功能实验测试均低于对侧肢体的90%；重建后12个月时，单脚跳及6 m计时单脚跳超过对侧肢体的90%，但侧边单脚跳及交叉单脚跳仍低于对侧肢体的90%。 2.6 不良反应发生情况 2例患者重建后胫前区轻度肿胀，无明显压痛，考虑系关节渗液经由空心钛挤压螺钉渗入胫前组织间隙所致，经消肿、对症治疗后症状好转。所有患者随访期间未发生韧带松动断裂，钛螺钉固定良好，无松动、脱出情况发生，膝关节屈伸功能严重受限情况发生。 "

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