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Knee Extensor and Flexor Force Control after ACL Injury and Reconstruction: A Systematic Review and Meta-Analysis.
Medicine & Science in Sports & Exercise ( IF 4.1 ) Pub Date : 2025-02-01 , DOI: 10.1249/mss.0000000000003574
Ava L Schwartz,Moein Koohestani,David A Sherman,Matt S Stock,Grant E Norte

PURPOSE Reduced force control after anterior cruciate ligament (ACL) injury and reconstruction may contribute to poor function. Various metrics (linear and nonlinear) have been employed to quantify force control. The aims of this review were to synthesize evidence assessing knee extensor and flexor force control after ACL injury (ACLD) or reconstruction (ACLR) and to investigate the potential effects of injury management (e.g., surgery, graft type), mode of contraction (e.g., isometric, isokinetic), and speed and intensity of contraction. METHODS We searched six databases for studies assessing knee extensor or flexor force control in individuals with ACLD or ACLR using a linear or nonlinear analysis method and comparing to the uninvolved limb or an uninjured control. Two independent reviewers assessed potential studies for inclusion and quality. Primary random effects meta-analyses were simultaneously separated by muscle, injury management, analysis method, and comparator. RESULTS Twenty-seven studies were included. When assessed via linear methods, greater variability in knee extensor force (i.e., reduced force control) was observed only in comparison to uninjured controls (ACLD: P = 0.03, Hedges' g = 0.22, [95% confidence interval CI 0.02-0.42]; ACLR: P = 0.01, Hedges' g = 0.23, [95% CI = 0.05-0.41]). When assessed via nonlinear methods, lesser regularity of knee extensor force control (i.e., reduced force control) was observed in comparison to the uninvolved limb (ACLD: P = 0.008, Hedges' g = 0.44, [95% CI = 0.11-0.76]; ACLR: P < 0.00001, Hedges' g = 0.75, [95% CI = 0.61-0.88]) and uninjured controls (ACLD: P = 0.002, Hedges' g = 0.44, [95% CI = 0.16-0.72]; ACLR: P < 0.00001, Hedges' g = 0.69, [95% CI = 0.55-0.82]). Funnel plot data suggested a potential risk of bias. CONCLUSIONS Moderate-to-strong evidence indicates impaired knee extensor force control after ACLR in comparison to uninjured controls, regardless of analysis type. Nonlinear analyses detected more and greater force control differences, thus appearing to be more sensitive and highlighting a need for a standardized, clinically accessible methodology. These results may be partially explained by the neuromuscular mechanisms underlying motor control.

中文翻译:


ACL 损伤和重建后的膝关节伸肌和屈肌力控制:系统评价和荟萃分析。



目的 前交叉韧带 (ACL) 损伤和重建后力控制减少可能导致功能不佳。已采用各种度量(线性和非线性)来量化力控制。本综述的目的是综合评估 ACL 损伤 (ACLD) 或重建 (ACLR) 后膝伸肌和屈肌力控制的证据,并调查损伤管理(例如手术、移植物类型)、收缩模式(例如等长、等速)以及收缩速度和强度的潜在影响。方法 我们检索了 6 个数据库,以查找使用线性或非线性分析方法评估 ACLD 或 ACLR 个体膝关节伸肌或屈肌力控制的研究,并与未受累肢体或未受伤的对照组进行比较。两名独立评价员评估了潜在研究的纳入和质量。主要随机效应荟萃分析按肌肉、损伤管理、分析方法和对照同时分离。结果 共纳入 27 项研究。当通过线性方法评估时,仅与未受伤的对照组相比,观察到膝关节伸肌力的更大变异性(即减少的力控制)(ACLD:P = 0.03,Hedges' g = 0.22,[95% 置信区间 CI 0.02-0.42];ACLR: P = 0.01,Hedges' g = 0.23,[95% CI = 0.05-0.41])。当通过非线性方法进行评估时,与未受累的肢体相比,观察到膝关节伸肌力控制的规律性较低(即减少的力控制)(ACLD:P = 0.008,Hedges' g = 0.44,[95% CI = 0.11-0.76];ACLR: P < 0.00001,Hedges' g = 0.75,[95% CI = 0.61-0.88])和未受伤的对照 (ACLD: P = 0.002,Hedges' g = 0.44,[95% CI = 0.16-0.72];ACLR: P < 0.00001,Hedges' g = 0.69,[95% CI = 0.55-0.82])。 漏斗图数据表明存在潜在的偏倚风险。结论 中等到强证据表明,与未受伤的对照组相比,ACLR 后膝关节伸肌力控制受损,无论分析类型如何。非线性分析检测到更多和更大的力控制差异,因此看起来更敏感,并突出了对标准化、临床可访问方法的需求。这些结果可能部分由运动控制背后的神经肌肉机制解释。
更新日期:2025-01-15
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