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

Abstract

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

CLC Number:

R686

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.

Figures/Tables 8

Table 1

Figure 1

Table 2

Calculation of dimensionless scaling for each gait indicator"

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	$l^= l l 0$

Table 2

Table 3

Table 4

Figure 2

Table 5

Figure 3

References 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

Risk assessment of return to sport based on gait data of athletes after anterior cruciate ligament reconstruction

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 8

References 40

Related Articles 15

Metrics

Comments

Recommended 0

[1]	TANG Letian, HUANG Zhaoxin, LIU Chao, XIAO Xiaofei. Effect of high blood flow restriction training on patients after anterior cruciate ligament reconstruction: a systematic review [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 789-796.
[2]	WEN Nana, ZHANG Xinhui, LONG Qing, WANG Yuhao, YU Qunping, ZHANG Hanchun, ZHENG Guohua. Predictive value of gait and balance on frailty in community-dwelling older adults in Shanghai, China [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(6): 731-736.
[3]	ZHENG Jianling, LIU Huilin, ZHU Lin, GU Bin, YAN Ruxiu, ZHAO Qi, SONG Luping. Effect of early intelligent assisted walking under suspension protection on motor and walking function for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 431-436.
[4]	YU Chunyang, LIU Ran, ZHAO Yishuang, GUO Shuai, ZHOU Ya'nan, LI Li, ZHANG Hao. Effect of virtual reality treadmill training on balance and gait in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 310-315.
[5]	GE Ying, ZHAO Wowa, ZHANG Lu, SHU Xuan, LI Jiawei, LIU Ying. Motor function and quality of life in Parkinson's disease patients with freezing of gait [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 339-344.
[6]	MA Qianfeng, LI Li, ZHANG Wei, DING Jian, XU Yilin, MAO Wenhui. Influence of different hardness surfaces on gait coordination in functional ankle instability [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 345-351.
[7]	LIU Hua, JIA Mingyue, DU Xiaoxia, YANG Yaru, LI Jing, LÜ Jihui. Physical fitness and characteristics of cognitive function among people aged 55 to 75 years with high and low risk of dementia in communities in Beijing [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 195-201.
[8]	WEI Mengli, ZHONG Yaping, ZHOU Yiwen, GUI Huixian, GUAN Yeming, YU Tingting. Difference in bilateral lower limb muscle synergy mode for gait in patients after unilateral anterior cruciate ligament reconstruction [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 95-104.
[9]	ZHAO Panchao, JI Zhongqiu, JIANG Guiping, WEN Ruixiang. Influence of different tasks on gait characteristics and task cost in early childhood [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1072-1082.
[10]	HU Xiaoshi, ZHANG Qi, YUE Qing, LIANG Yanhua, LI Xiaosong, FENG Amei, ZHANG Yanqing. Effect of orthopedic elastic bandages on gait symmetry and walking ability in children with spastic hemiplegic cerebral palsy [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1083-1089.
[11]	MA Shengnan, KE Jingyue, DONG Hongming, LI Jianping, ZHANG Honghao, LIU Chao, SHEN Shuang, LI Guqiang. Effect of core stability training on dynamic balance and surface electromyography after anterior cruciate ligament reconstruction [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 882-889.
[12]	ZHANG Yibin, LÜ Jie, YU Hongliu. Gait phase recognition in intelligent above-knee prosthesis based on fuzzy logic algorithm [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 896-902.
[13]	WANG Yiji, ZHOU Hongjun, HE Zejia, LIU Genlin, ZHENG Ying, HAO Chunxia, WEI Bo, KANG Haiqiong, ZHANG Ying, LU Xiaolei, YUAN Yuan, MENG Qianru. Relationship between symmetry of lower limb function and gait symmetry in patients with incomplete spinal cord injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 639-645.
[14]	ZHANG Yibin, LI Jianfeng, YU Hongliu. A microprocessor-controlled prosthetic knee and its gait symmetry assessment [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(4): 402-407.
[15]	WANG Fang, YANG Tao, HE Yaoguang, CAO Zijun, LIU Guoqing, HU Jun, ZHANG Jianguo, FAN Yubo. Design of variable stiffness insole based on diabetics plantar pressure during gait period [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(4): 408-415.