基于运动员前交叉韧带重建术后步态数据分析重返运动的风险

doi:10.3969/j.issn.1006-9771.2024.08.010

摘要/Abstract

摘要：

目的基于运动员前交叉韧带重建术(ACLR)术后的步态数据，分析其重返运动的风险。

方法 2023年5月至6月，在武汉体育学院招募ACLR术后运动员39例，采用三维动作捕捉系统、表面肌电和三维测力台，记录稳定步态和串联步态数据，并采用K-STARTS测试计算重返运动得分。各步态指标与K-STARTS测试总分之间的关系采用Pearson相关性分析，其中关键指标与重返运动的风险采用线性回归分析。

结果在稳定步态中，步时与K-STARTS测试总分呈负相关(r = -0.479, P = 0.002)，股直肌(r = 0.448, P = 0.004)和股外侧肌(r = 0.595, P = 0.001)的激活峰值振幅对称指数与K-STARTS测试总分均呈显著正相关。在串联步态中，重心横向位移距离与K-STARTS测试总分呈显著负相关(r = -0.341, P = 0.034)，股外侧肌的激活峰值振幅出现时间对称指数与K-STARTS测试总分呈正相关(r = 0.320, P = 0.047)。回归分析显示，基于稳定步态构建的模型(F = 15.818, P = 0.001, R² = 0.650)的解释度优于基于串联步态构建的模型(F = 7.692, P = 0.001, R² = 0.397)。

结论在稳定步态中，步态节奏变异性、对称性指标与重返运动风险相关；在串联步态中，步态平衡性、对称性指标与重返运动风险相关；相比于串联步态，基于稳定步态信息构建的重返运动风险评估模型的解释度更佳，可能更适合作为重返运动风险测试的简易方法。

关键词: 前交叉韧带重建术, 重返运动, 步态, 风险评估模型, 运动员, 运动损伤

Abstract:

Objective To analyze the risk of return to sport in athletes using their gait data following anterior cruciate ligament reconstruction (ACLR).

Methods From May to June, 2023, 39 athletes after ACLR were recruited in Wuhan Sports University. Their data on stable gait and tandem gait were recorded using a three-dimensional motion capture system, surface electromyography and a three-dimensional ergometer table. Additionally, return-to-sport scores were calculated using the K-STARTS test. The relationship between each gait indicator and the total score of the K-STARTS test was analyzed with Pearson correlation analysis. Furthermore, the key indicators related to the risk of return to sport were analyzed using linear regression.

Results In the stable gait test, the step time was negatively correlated with the total score of K-STARTS (r = -0.479, P = 0.002), and the peak amplitude symmetry index of rectus femoris (r= 0.448, P = 0.004) and vastus lateralis (r= 0.595, P = 0.001) were positively correlated with the total score of K-STARTS. In the tandem gait test, the lateral displacement distance of the center of gravity was negatively correlated with the total score of K-STARTS (r = -0.341, P= 0.034), and the time symmetry index of peak amplitude of vastus lateralis was positively correlated with the total score of K-STARTS (r= 0.320, P = 0.047). Regression analysis showed that the interpretation of the model based on stable gait (F = 15.818, P= 0.001, R² = 0.650) was better than that based on tandem gait (F = 7.692, P = 0.001, R² = 0.397).

Conclusions In stable gait, gait rhythm variability and symmetry are correlated with return to sport risk. In tandem gait, gait balance and symmetry indexes are correlated with return-to-sport risk. Compared with tandem gait, the interpretation of return-to-sport risk assessment model based on stable gait information is better, and may be more suitable as a simple return-to-sport risk test method.

Key words: anterior cruciate ligament reconstruction, return to sport, gait, risk assessment model, athlete, sports injury

中图分类号:

R686

周易文, 钟亚平, 魏梦力, 王海锋, 余绍华, 桂辉贤. 基于运动员前交叉韧带重建术后步态数据分析重返运动的风险[J]. 《中国康复理论与实践》, 2024, 30(8): 948-956.

ZHOU Yiwen, ZHONG Yaping, WEI Mengli, WANG Haifeng, YU Shaohua, GUI Huixian. Risk assessment of return to sport based on gait data of athletes after anterior cruciate ligament reconstruction[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 948-956.

图/表 8

表1

图1

表2

各步态指标无量纲化缩放计算方法"

指标	无量纲化缩放计算方法
速度类指标	$v^= v g l 0$
时间类指标	$t^= t l 0 g$
肌电振幅类指标	$E M^G i = E M G i E M G m a x$
关节角度类指标	原值
距离类指标	$l^= l l 0$

表2

表3

表4

图2

表5

图3

参考文献 40

[1]	KOTSIFAKI R, SIDERIS V, KING E, et al. Performance and symmetry measures during vertical jump testing at return to sport after ACL reconstruction[J]. Br J Sports Med, 2023, 57(20): 1304-1310.
[2]	魏铭, 牛雪松, 李楠. 徐梦桃前交叉韧带重建术后康复训练的应用与分析[J]. 体育科学, 2021, 41(8): 25-33.
	WEI M, NIU X S, LI N. Application and analysis of rehabilitation training for Xu Mengtao after anterior cruciate ligament reconstruction[J]. Sports Sci, 2021, 41(8): 25-33.
[3]	TURK R, SHAH S, CHILTON M, et al. Return to sport after anterior cruciate ligament reconstruction requires evaluation of > 2 functional tests, psychological readiness, quadriceps/hamstring strength, and time after surgery of 8 months[J]. Arthroscopy, 2023, 39(3): 790-801.
[4]	SLATER L V, HART J M, KELLY A R, et al. Progressive changes in walking kinematics and kinetics after anterior cruciate ligament injury and reconstruction: a review and meta-analysis[J]. J Athl Train, 2017, 52(9): 847-860.
[5]	GOKELER A, GRASSI A, HOOGESLAG R, et al. Return to sports after ACL injury 5 years from now: 10 things we must do[J]. J Exp Orthop, 2022, 9(1): 73.
[6]	WELLING W. Return to sports after an ACL reconstruction in 2024: A glass half full? A narrative review[J]. Physic Thera Sport, 2024, 67: 141-148.
[7]	SINSURIN K, KIRATISIN P, IRAWAN D S, et al. Residual deficits of knee and hip joint coordination and clinical performance after return to sports in athletes with anterior cruciate ligament reconstruction[J]. Knee Surg Relat Res, 2024, 36(1): 22.
[8]	ORONOWICZ J, SEIL R, HRTERER H, et al. Anterior cruciate ligament injuries in elite ski jumping reliably allow return to competition but severely affect future top performance[J]. Knee Surg Sports Traumatol Arthrosc, 2024, 32(3): 616-622.
[9]	JACK R A, LAMBERT B S, HEDT C A, et al. Blood flow restriction therapy preserves lower extremity bone and muscle mass after ACL reconstruction[J]. Sports Health, 2023, 15(3): 361-371.
[10]	SAYER T A, MENCK N V, RERA J, et al. Is it time to develop specific return to running criteria for ACL rehabilitation? An international survey of physiotherapists criteria for return to running following ACL injury[J]. Phys Thera Sport, 2024, 67: 19-24.
[11]	FRANCK F, SAITHNA A, VIEIRA T D, et al. Return to sport composite test after anterior cruciate ligament reconstruction (K-STARTS): factors affecting return to sport test score in a retrospective analysis of 676 patients[J]. Sports Health, 2021, 13(4): 364-372. doi: 10.1177/1941738120978240 pmid: 33550916
[12]	BLAKENEY W G, OUANEZAR H, ROGOWSKI I, et al. Validation of a composite test for assessment of readiness for return to sports after anterior cruciate ligament reconstruction: the K-STARTS test[J]. Sports Health, 2018, 10(6): 515-522. doi: 10.1177/1941738118786454 pmid: 30024344
[13]	JOHNOSON J L, CAPIN J J, ARUNDALE A J H, et al. A secondary injury prevention program may decrease contralater al anterior cruciate ligament injuries in female athletes: 2-year injury rates in the ACL-SPORTS randomized controlled trial[J]. J Orthop Sports Phys Ther, 2020, 50(9): 523-530.
[14]	MANIAR N, COLE M H, BRYANT A L, et al. Muscle force contributions to anterior cruciate ligament loading[J]. Sports Med, 2022, 52(8): 1737-1750. doi: 10.1007/s40279-022-01674-3 pmid: 35437711
[15]	CHIA L, DE D, WHALAN M, et al. Non-contact anterior cruciate ligament injury epidemiology in team-ball sports: a systematic review with meta-analysis by sex, age, sport, participation level, and exposure type[J]. Sports Med, 2022, 52(10): 2447-2467.
[16]	READ P, MC AULIFFE S, WILSON M G, et al. Better reporting standards are needed to enhance the quality of hop testing in the setting of ACL return to sport decisions: a narrative review[J]. Br J Sports Med, 2021, 55(1): 23-29.
[17]	NAMBI G, ABDELBASSET W K, VERMA A, et al. Effects of postoperative rehabilitation on gait parameters and electromyography variables in acute and chronic anterior cruciate ligament reconstruction surgery in football players[J]. Evid Based Complement Alternat Med, 2021, 13: 9912795.
[18]	MINNING S J, MYER G D, MANGINE R E, et al. Serial assessments to determine normalization of gait following anterior cruciate ligament reconstruction[J]. Scand J Med Sci Sports, 2009, 19(4): 569-575.
[19]	DI STASI S L, LOGERSTEDT D, GARDINIER E S, et al. Gait patterns differ between ACL-reconstructed athletes who pass return-to-sport criteria and those who fail[J]. Am J Sports Med, 2013, 41(6): 1310-1318. doi: 10.1177/0363546513482718 pmid: 23562809
[20]	时会娟, 丁立, 任爽, 等. 前交叉韧带重建术后步行过程中的生物力学特征[J]. 科技导报, 2020, 38(6): 25-33. doi: 10.3981/j.issn.1000-7857.2020.06.003
	SHI H J, DING L, REN S, et al. Biomechanical characteristics of walking after anterior cruciate ligament reconstruction[J]. Sci Technol Rev, 2020, 38(6): 25-33.
[21]	ZARZYCKI R, FAILLA M, CAPIN J J, et al. Psychological readiness to return to sport is associated with knee kinematic asymmetry during gait following anterior cruciate ligament reconstruction[J]. J Orthop Sports Phys Ther, 2018, 48(12): 968-973.
[22]	SIMONSSON R, PIUSSI R, HGBERG J, et al. Rehabilitation and return to sport after anterior cruciate ligament reconstruction[J]. Clin Sports Med, 2024, 43(3): 513-533.
[23]	ADHITYA I P G S, YU W Y, KURNIAWATI I, et al. Risk factors of knee reinjury after anterior cruciate ligament reconstruction[J]. Int Ortho, 2024, 48(4): 983-990.
[24]	王玲, 姜霞, 陈鹏, 等. 前交叉韧带重建患者双腿垂直跳跃期间的下肢生物力学特征[J]. 中国组织工程研究, 2024, 28(14): 2215-2220.
	WANG L, JIANG X, CHEN P, et al. Lower limb biomechanical characteristics during vertical jump of both legs in patients undergoing anterior cruciate ligament reconstruction[J]. Chin J Tiss Eng Res, 2024, 28(14): 2215-2220.
[25]	周敬滨, 李国平, 李方祥. 慢性膝关节前交叉韧带损伤患者步态的运动学分析[J]. 中国运动医学杂志, 2012, 31(10): 898-901, 912.
	ZHOU J B, LI G P, LI F X. Patients with chronic knee anterior cruciate ligament injury gait kinematics analysis[J]. Chin J Sports Med, 2012, 31(10): 898-901, 912.
[26]	YOO D, KANG K C, LEE J H, et al. Diagnostic usefulness of 10-step tandem gait test for the patient with degenerative cervical myelopathy[J]. Sci Rep, 2021, 11(1): 17212. doi: 10.1038/s41598-021-96725-6 pmid: 34446786
[27]	GRINBERG Y, BERKOWITZ S, HERSHKOVITZ L, et al. The ability of the instrumented tandem walking tests to discriminate fully ambulatory people with MS from healthy adults[J]. Gait Posture, 2019, 70: 90-94. doi: S0966-6362(18)31844-7 pmid: 30831545
[28]	李玉周, 王婧怡, 胡军. 前交叉韧带重建术后短期足底压力分布及平衡特征研究[J]. 体育科学, 2020, 40(5): 8.
	LI Y Z, WANG J Y, HU J. Short-term plantar pressure distribution and balance characteristics after anterior cruciate ligament reconstruction[J]. Sport Sci, 2020, 40(5): 8.
[29]	王奇奇, 徐朱杰, 冯德宏, 等. 步态分析在前交叉韧带损伤中的应用[J]. 实用骨科杂志, 2021, 27(12): 1112-1116.
[30]	ZARZYCKI R, CUMMER K, ARHOS E, et al. Female athletes with better psychological readiness are at higher risk for second acl injury after primary ACL reconstruction[J]. Sports Health, 2024, 16(1): 149-154.
[31]	KOBSAR D, OSIS S T, PHINYOMARK A, et al. Reliability of gait analysis using wearable sensors in patients with knee osteoarthritis[J]. J Biomech, 2016, 49(16): 3977-3982. doi: S0021-9290(16)31226-X pmid: 27889189
[32]	HADIZADEH M, AMRI S, ROOHI SA, et al. Assessment of gait symmetry improvements in national athletes after anterior cruciate ligament reconstruction during rehabilitation[J]. Int J Sports Med, 2016, 37(12): 997-1002. pmid: 27551935
[33]	魏梦力, 钟亚平, 周易文, 等. 单侧前交叉韧带重建患者步行双侧下肢肌肉协同模式差异[J]. 中国康复理论与实践, 2024, 30(1): 95-104. doi: 10.3969/j.issn.1006-9771.2024.01.013
	WEI M L, ZHONG Y P, ZHOU Y W, et al. Patients with unilateral anterior cruciate ligament reconstruction on bilateral lower limb muscle coordination patterns differences[J]. Chin Rehabil Theory Pract, 2024, 30(1): 95-104.
[34]	VISSCHER R M S, SANSGIRI S, FRESLIER M, et al. Towards validation and standardization of automatic gait event identification algorithms for use in paediatric pathological populations[J]. Gait Posture, 2021, 86: 64-69. doi: 10.1016/j.gaitpost.2021.02.031 pmid: 33684617
[35]	CLARK D J. Automaticity of walking: functional significance, mechanisms, measurement and rehabilitation strategies[J]. Front Hum Neurosci, 2015, 5(9): 246.
[36]	SHARIFI A, ESMAEILI H, ZOLAKTAF V. Walking and running roll-off characteristics in patients with ACL reconstruction history[J]. Gait Posture, 2024, 107: 330-336.
[37]	马圣楠, 柯竟悦, 董洪铭, 等. 前交叉韧带重建后静态站立及步行时的平衡和步态特征[J]. 中国组织工程研究, 2023, 27(36): 5784-5789.
	MA S N, KE J Y, DONG H M, et al. Static standing and walking after anterior cruciate ligament reconstruction of balance and gait features[J]. J Tiss Eng Res Chin, 2023, 27(36): 5784-5789.
[38]	GOKELER A, NEUHAUS D, BENJAMINSE A, et al. Principles of motor learning to support neuroplasticity after ACL Injury: implications for optimizing performance and reducing risk of second ACL injury[J]. Sports Med, 2019, 49(6): 853-865. doi: 10.1007/s40279-019-01058-0 pmid: 30719683
[39]	张美珍. 非接触性前交叉韧带损伤危险因素的生物力学研究[D]. 北京: 北京体育大学, 2012.
	ZHANG M Z. Biomechanical study on risk factors of non-contact anterior cruciate ligament injury[D]. Beijing: Beijing Sport University, 2012.
[40]	MANTASHLOO Z, LETAFATKAR A, MORADI M. Vertical ground reaction force and knee muscle activation asymmetries in patients with ACL reconstruction compared to healthy individuals[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(6): 2009-2014.

性别	n	身高/cm	体质量/kg	年龄/岁
男	29	176.86±6.83	72.28±7.75	21.72±3.41
女	10	169.60±5.99	58.00±5.14	20.50±1.51

变量	稳定步态		串联步态
变量	r值	P值	r值	P值
SL	0.066	0.688
ST	-0.479	0.002	-0.155	0.347
SS	0.242	0.138	0.195	0.233
SL SD	-0.208	0.203
ST SD	-0.223	0.172	0.186	0.258
SS SD	-0.198	0.226	0.167	0.309
COM LDD	0.028	0.868	-0.341	0.034
COM LDS	0.107	0.517	-0.109	0.508
COP LDD	0.092	0.575	0.019	0.908
COP LDS	0.227	0.165	0.073	0.659
KJA IC	0.091	0.581	0.189	0.250
HJA IC	-0.149	0.365	-0.127	0.441
Min KFA SP	-0.036	0.828	-0.091	0.582
Min HFA SP	-0.163	0.322	0.055	0.740
SI PAA-VM	0.029	0.863	-0.108	0.512
SI PAA-RF	0.448	0.004	-0.110	0.504
SI PAA-VL	0.595	0.001	0.043	0.795
SI PAA-BF	0.027	0.871	-0.072	0.665
SI PAA-TA	0.081	0.622	0.133	0.418
SI PAA-GM	0.115	0.486	-0.275	0.090
SI PAA-GL	-0.103	0.531	0.060	0.685
SI TPAA-VM	-0.073	0.658	-0.300	0.064
SI TPAA-RF	0.124	0.453	0.080	0.628
SI TPAA-VL	0.194	0.238	0.320	0.047
SI TPAA-BF	0.225	0.168	0.066	0.688
SI TPAA-TA	-0.057	0.731	0.021	0.898
SI TPAA-GM	0.096	0.561	-0.016	0.925
SI TPAA-GL	-0.120	0.465	-0.192	0.243

预测变量	非标准化系数		β	t值	P值
预测变量	B	标准误	β	t值	P值
常数	15.748	6.109		2.578	0.014
ST	-3.226	1.451	-0.250	-2.251	0.031
SI PAA-RF	1.835	0.630	0.319	2.912	0.006
SI PAA-VL	2.658	1.086	0.291	2.448	0.020
ACL-RSI	1.767	0.478	0.396	3.699	0.001

预测变量	非标准化系数		β	t值	P值
预测变量	B	标准误	β	t值	P值
常数	9.744	1.891		5.152	0.001
COM LDD	-9995.523	5630.445	-0.242	-21.775	0.085
SI TPAA-VL	0.678	0.397	0.232	1.707	0.097
ACL-RSI	1.968	0.630	0.437	3.125	0.004