前十字韌帶重建運動員的功能性表現與穿戴護膝之成效

Abstract

目的：藉由功能性動作的評估來探討前十字韌帶重建運動員重返運動場後是否仍有問題並以功能性護膝做為介入，探討其效果。方法：招募10名前十字韌帶重建運動員為重建組 (年齡：22.4±1.0 歲；身高：169.4±8.6 公分；體重：65.6±10.7 公斤；受傷至手術的時間：5.6±5.1 月；手術至實驗的時間：24.5±16.3 月) 以及10名性別、年齡、身高、體重與運動項目必須配對的運動員為控制組 (年齡：21.5±1.8 歲；身高：167.6±8.3 公分；體重：64.1±11.6 公斤)。首先，所有受試者皆須完成肌力和跳躍表現的測試，以瞭解受試者的狀況。緊接著，受試者須完成側向切入和躍起著地的動作測試，其中重建組需要穿戴功能性護膝進行實驗。所有的結果皆以無母數統計進行考驗。所得到的結論如下：前十字韌帶重建運動員的肌力雖然已經恢復，但其在執行側向切入和躍起著地時，仍然有膝關節運動學、關節協調表現、動態姿勢穩定方面的缺陷，因此，推測手術後膝關節的本體感覺和感覺動作控制系統的功能可能尚未完全恢復，而影響神經肌肉控制的能力。當以功能性護膝介入時，前十字韌帶重建運動員的膝關節運動學、關節協調表現和動態姿勢穩定能力都有改善的情形，其原因可能與護膝本身的設計和穿戴後可能會刺激膝關節周邊的本體感覺受器有關，而造成這些修正或改善。因此對於前十字韌帶重建的運動員來說，穿戴此款護膝或許能幫助減少神經肌肉控制系統的負荷，並減少二次傷害發生的機率。Purpose: To evaluate functional movements after returning to sports following anterior cruciate ligament reconstruction (ACLR) and to access the effectiveness of the functional knee brace during functional movements. Method: Ten athletes with a history of unilateral ACLR surgery were served as experimental group (Age: 22.4±1.0 years old; Height: 169.4±8.6 cm; Weight: 65.6±10.7 kg; Time from injury to surgery: 5.6±5.1 months; Time since surgery: 24.5±16.3 months) and 10 sex-, age-, height-, weight- and sport-matched athletes were served as control group (Age: 21.5±1.8 years old; Height: 167.6±8.3 cm; Weight: 64.1±11.6 kg). First, all subjects were required to complete knee muscle strength and hop performance tests to understand their recovery state. Second, all subjects needed to complete cutting and jump-landing protocol. Nonparametric test was used to compare each parameter (α = .05). Conclusion: Although the ACLR athletes have restored their knee muscle strength, abnormal knee kinematics, joint coordination and dynamic postural stability still existed during cutting and jump-landing tasks. It is possible that such lacks in ACLR athletes were associated with their poor proprioceptive function, and this might affect their neuromuscular control ability. However, such lacks have been improved while wearing a functional knee brace, which might attribute to the knee design and it may stimulate the proprioceptive receptors around the knee. Hence, wearing a function knee brace may improve the neuromuscular control ability after ACLR and reduce the rate of second injury.