發力率訓練與冷療對前十字韌帶重建術後女性股四頭肌功能與額狀面落地生物力學的影響

Abstract

研究背景:女性為前十字韌帶 (anterior cruciate ligament, ACL) 傷害好發族群，術 後常出現關節性肌肉自主抑制 (arthrogenic muscle inhibition, AMI)，導致股四頭肌功能 下降與落地控制受損。儘管冷療與發力率訓練可改善此現象，目前尚缺乏探討其對術後 女性肌肉功能與額狀面生物力學影響之研究。研究方法:本研究共招募 18 名 ACL 重 建術後女性，依隨機方式分為控制組 (n = 5)、訓練組 (n = 6) 與冰敷訓練組 (n = 7)，進 行為期 8 週、每週 3 次的介入訓練。介入前後測量股四頭肌最大等長收縮力 (maximal voluntary isometric contraction, MVIC)、中樞活化比 (central activation ratio, CAR)、絕對 發力率 (absolute rate of torque development, aRTD)、標準化發力率 (normalized RTD, nRTD)，並評估單腳與雙腳落地任務中的額狀面風險參數。研究結果:三組在肌肉功能 指標上皆未出現顯著差異，僅冰敷訓練組呈現 CAR 較大提升趨勢 (+2.5%)，但 aRTD 反而下降。前測 CAR 與 aRTD 之間呈顯著正相關 (r = .622，p = .006)，顯示 AMI 仍 對發力能力具有神經性限制。部分落地風險參數出現時間主效應，整體落地趨勢朝風險 方向改變，惟冰敷訓練組變化相對穩定。進一步分析顯示，在冰敷訓練組中，aRTD 變化量可顯著預測髖內收角度變化 (β = −0.763，p = .010);在雙腳落地任務中，aRTD 的 提升則與軀幹側屈角度變化呈正相關 (β = 0.717，p = .048)，反映部分受試者仍存在偏移 與補償模式。結論與建議:單一訓練策略難以全面改善 ACL 術後女性的肌肉功能與落 地風險。RTD 的預測效果受限於介入方式、AMI 狀態與動作型態等交互調節因素。臨 床上建議針對術後數月仍有神經抑制與肌力不足者，應結合去抑制策略與中樞導向訓練 模式，並強化近端穩定性與動作策略調整，以促進股四頭肌功能恢復與降低 ACL 再傷 研 究 生:李明修 指導教授:黃昱倫 風險。Background: Females are a high-risk population for anterior cruciate ligament (ACL) injuries and often experience arthrogenic muscle inhibition (AMI) following reconstruction surgery, leading to quadriceps dysfunction and impaired landing control. Although cryotherapy and rate of torque development (RTD) training have shown potential in improving neuromuscular function, research investigating their effects on postoperative quadriceps performance and frontal plane biomechanics in females remains limited. Methods: This study recruited 18 females who had undergone ACL reconstruction and randomly assigned them to a control group (n = 5), a training group (n = 6), or a cryotherapy training group (n = 7). All participants completed an 8-week intervention, three sessions per week. Pre- and post- intervention assessments included maximal voluntary isometric contraction (MVIC), central activation ratio (CAR), absolute RTD (aRTD), normalized RTD (nRTD), and frontal plane biomechanical parameters during single- and double-leg landing tasks. Results: No significant between-group differences were observed in muscle function outcomes. However, the cryotherapy training group showed a greater trend toward increased CAR (+2.5%) alongside a decrease in aRTD. At baseline, CAR and aRTD were significantly correlated (r = .622, p = .006), suggesting a persistent neural inhibition effect due to AMI. Some frontal plane risk factors exhibited significant time effects, with overall landing patterns shifting toward a riskier direction, though the cryotherapy group maintained more stable biomechanical performance. Further analysis revealed that changes in aRTD significantly predicted changes in hip adduction Author: Li, Ming-Shiou Advisor: Huang, Yu-Lun angle in the cryotherapy group (β = −0.763, p = .010). Additionally, in the double-leg landing task, increased aRTD was positively associated with changes in trunk lateral flexion (β = 0.717, p = .048), indicating compensatory strategies among some participants. Conclusion: A single intervention strategy appears insufficient to comprehensively improve quadriceps function and landing biomechanics in females post-ACL reconstruction. The predictive power of RTD is influenced by the interaction of intervention type, AMI status, and movement patterns. Clinically, it is recommended to integrate AMI-reducing strategies with central motor control– oriented training, alongside proximal stability and landing technique refinement, to enhance recovery and reduce the risk of ACL reinjury.