前十字韌帶重建後肌力與回場測試通過率之分析

Analysis of muscle strength recovery and rate of return to sport after Anterior Cruciate Ligament reconstruction

張乃元(Nai-Yuan Chang)

指導教授 ： 周伯禧

高雄醫學大學/醫學院/運動醫學系碩士班/碩士(2020年)

摘要

背景：前十字韌帶重建(Anterior Cruciate Ligament Reconstruction , ACLR)後最常見的回場前目標是達到對稱的肌力（LSI, Limb symmetry index）、恢復平衡與協調、找回本體感覺及弭平心理因素，目前對於ACLR後回到原先運動強度族群之肌力與肌力對稱性並未明確探討，是否有臨床閾值能應用到評估膝關節表現恢復好壞還尚未明確。
目的：1.建立股四頭肌肌力以及LSI閾值給醫療人員作為ACLR後患者恢復狀況的評估標準。2.提供更常見的肌力測試方式以提高患者接受回場測試的普及率。
研究方法：本研究納入32位ACLR受試者與16位建康男性與女性作為受試者，受試者會填寫IKDC、Lysholm、Tegner問卷並回報ACLR後運動強度狀況並分為Return to preinjury or higher level （Group1）、Return to lower level（Group2）與控制組（Group3），受試者雙腳都需接受2項肌力測試（等速肌力測試與最大肌力測試）與4項跳躍（Single-leg hop for distance /Triple-leg hop for distance / Cross-over hop /Side-hop）測試，使用Receiver operator characteristic（ROC）曲線建立肌力與LSI閾值，使用二元邏輯回歸分析兩項肌力測試方法的相關性與準確度。
結果：本研究回場測試通過率分別Group1:38%、Group2:13%、Group3:31%。通過ROC曲線分析後，本研究建議患側腳之股四頭肌等速肌力測試閾值為2.345Nm/kg（AUC=0.729, p=0.009）其敏感度為0.769，特異度為0.743。股四頭肌器械式最大肌力測試閾值為0.527kg/kg（AUC=0.776, p=0.005）其敏感度為0.769，特異度為0.686。患側腳之股四頭肌等速肌力LSI閾值為89.8%（AUC=0.809, p=0.001）其敏感度為1，特異度為0.6。
結論：前十字韌帶重建後要能夠回場有很多的因素，包括肌力、本體感覺、平衡感、關節穩定性、下肢LSI的測試與心理層面，本篇研究單純以肌力為切入點，探討肌力大小與目前前十字韌帶重建後主流的回場測試進行詳細的分析。我們建議肌力數值可以達到2.345Nm/kg或是0.527kg/kg以上，股四頭肌LSI值達到89.8%，腿後肌LSI值達到95.4%以上，我們發現等速肌力2.345Nm/kg這個指標的特異度（0.743）較高，對於是否有機會通過回場測試具有不錯的辨認度

關鍵字

前十字韌帶斷裂 ； 傷後回場 ； 肌力標準 ； 回場標準 ； 前十字韌帶重建

並列摘要

Background：The most common goal following anterior cruciate ligament reconstruction (ACLR) is to achieve normal and symmetrical muscle strength, restore balance, coordination, proprioception, and overcome psychological barriers. Currently, the clinical thresholds for quadriceps strength and quadriceps symmetry associated with positive outcomes following return to sport (RTS) are unclear.
Objective: To establish cutoffs for clinical assessment of single-leg one-repetition maximum testing on leg extension machine and isokinetic knee extension testing following RTS after ACLR. Provide alternate selections of knee muscle strength testing to increase the use of RTS criteria for ACLR patients.
Method: Knee isokinetic peak torque was measured with an isokinetic dynamometer. Single-leg one-repetition maximum (1RM) was measured on leg extension/curl machine. Normalized knee extension torque (Nm/kg) and normalized knee 1RM data(kg/kg) were measured bilaterally in all participants. Physical performance (single-legged hop tests, triple-leg hop test, Crossover hop test, side hop test) and patient-reported outcomes (International Knee Documentation Committee questionnaire, Tegner Activity scale and Lysholm Knee questionnaire ) were also recorded. Receiver operator characteristic (ROC) curves were utilized to establish thresholds for unilateral measures of normalized knee muscle strength as well as limb symmetry indices (LSI).
Result:
Overall RTS pass rate was Group1: 38%, Group 2: 13%, Group 3: 31%. Unilateral normalized knee extension strength above 2.54 Nm/kg（AUC=0.729, p=0.009）and 0.527 kg/kg（AUC=0.776, p=0.005）, quadriceps LSI above 89.8% and hamstring LSI above 95.4% were the best indicators of predicting outcome of patients after ACLR.
Conclusion:
We suggest that the unilateral knee extension strength exceed 2.345Nm/kg or 0.527kg/kg, quadriceps and hamstrung LSI value exceed 89.8% and 95.4% respectively. We also found the specificity(0.743) of isokinetic knee extension threshold is high enough to recognize those patients who can’t pass RTS criteria.

並列關鍵字

ACLR ； Anterior Cruciate Ligament reconstruction ； Return to play ； Return to sport ； Strength cruteria

參考文獻

英文參考文獻

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