| Objective:The purpose of this study is to explore the evaluation of the muscle strength afteranterior cruciate ligament tore and the muscle strength changes post of ACL-reconstructionwith autologous hamstring tendon, and to provide theoretical evidence for postoperativerehabilitation program;To analyse the isometric muscle strength, isokinetic muscle strengthand characteristics of changes in electromyography after anterior cruciate ligament injury,compare the effects on the hamstring muscle strength and electromyography of earlyapplication of conventional rehabilitation,isometric contraction and neuromuscular electricalstimulation, to provide the theory reference and application evidence in effectively prevent thehamstring muscle strength decrease and functional recovery of knee joint postoperativeACL-reconstruction with autologous hamstring tendon, to improve the quality of life ofpatients in early stage.Methods: There are30male patients of ACLR with autologous hamstrings took part in thisstudy,which were randomly divided into conventional rehabilitation group(controlgroup),isometric and neuromuscular group,each group with10patients, both groups began theconventional rehabilitation protocol3days post-operation, the isometric group also receivedthe involved hamstrings isometric exercise,the neuromuscular group also received theinvolved hamstrings neuromuscular electrostimulation.Main measurement including thefollows:the isometric strength and the isokinetic strength of the involved hamstrings byBIO-DEX system Ⅲ,the electromechnical delay time and contrature sustain time of theinvolved hamstrings by Tensiomyography.Intenational Knee Documentation Committeescoring system and KT-2000for subjective knee joint functional assessment.Using PHILIPSiE33Doppler ultrasound to measure the hamstring tendons regeneration.Results:The isometric strength: There were no difference between3groups of the involved anduninvolved hamstrings before operation; Isometric strength of the involved and uninvolvedhamstrings was decreased postoperation, the conventional group significantly decreased thanthe isometric group and NMES group(P <0.05and P <0.01), there was no difference betweenisometric group and NMES group.The isokinetic muscle strength:The three velocity of the involved hamstringpeaktorque/bodyweight decreased obviously than the uninvolved, but without significant differences between3groups (P>0.05);The3groups of patients with three velocity bilateralknee H/Q ratio were higher than normal reference range, which is related to the anteriorcruciate ligament injury after hamstring muscle strength decline, and the involved H/Q ratioslightly larger than the uninvolved, there were no significant difference of three velocity kneeH/Q ratio between the three groups (P>0.05);The time to peak torque of the involvedhamstring in three velocity and all subjects is longer than the healthy side, the longest timeaveraged more than1second, and with the increase of velocity of shortening the time to peaktorque, no significant difference between the three groups (P>0.05).Tensiomyography:The semitendinosus EMD: preoperative and postoperative three groups of patients withinvolved semitendinosus EMD were increased compare to the uninvolved side, there was nosignificant difference between the three groups of the preoperative statistic(P>0.05).Thepostoperative EMD of the NMES group increased less than the conventional rehabilitationgroup and isometric group, have significant difference (P <0.05and P <0.01). The isometricgroup and the conventional rehabilitation group had no significant difference (P>0.05). EMDof the uninvolved hamstring postoperative has no difference between the three groups (P>0.05), but the NMES group increased less than the conventional rehabilitation group andisometric group had significant difference (P <0.01).The biceps femoris EMD: three groups of subjects preoperative EMD involved-side longerthan the uninvolved-side, but no significant difference between three groups. Three groups ofsubjects postoperative EMD involved-side longer than the uninvolved-side, the isometricgroup and the conventional rehabilitation group had significant difference (P <0.05), NMESgroup and conventional rehabilitation group and isometric groups have no difference, but theNMES group increased less than the conventional rehabilitation group.The semitendinosus Ts: three groups of subjects preoperative involved-side semitendinosusmuscle contraction duration increased than the uninvolved-side, no significant differencebetween the three groups. The involved semitendinosus postoperative muscle contractionduration in isometric group and NMES group decreased than the uninvolved-side, but nodifference between the two groups.The biceps femoris Ts: the three groups both uninvolved-side and involved-side musclecontraction duration either preoperative or postoperative had no significant difference. Ultrasound: significant differences between involved and uninvolved medial knee joint linelevel4cm cross-sectional width and cross-sectional area(P <0.05), there is no significantdifference of the thickness between two sides, the insertion of regenerated tendon near the endaverage13.788cm compared to the uninvolved side.IKDC score: there were no differences in three groups of patients with IKDC scores beforeoperation(P>0.05), after3months of ACLR three groups of patients with IKDC scores werehigher than those before operation, but no significant difference. The difference ofpreoperative and postoperative in three groups, difference of conventional rehabilitation groupthan in the isometric group significantly (P <0.05).KT-2000test: there were no differences of left-right side of the knee KT2000test in threegroups before ACLR, after3months of ACLR, the difference of left-right side in isometricgroup than in the conventional rehabilitation group differences (P <0.05); The NMES groupthan in the conventional rehabilitation group significantly (P <0.01).Conclusions:⑴Isometric, isokinetic muscle strength of relative peak torque, peak torque time,H/Q ratio and EMD can accurately evaluate the injury of anterior cruciate ligament and afterACLR with hamstring muscle strength change early;⑵The EMD and the Ts of the involvedhamstring elongated;⑶The early postoperative NMES can effectively prevent the musclestrength decrease and electromechanical delay elongate in the ACLR with autologoushamstring tendon, so as to promote the knee stability and function recover.⑷Theneuromuscular electrical stimulation can be used as an important part of ACLR postoperativerehabilitation program, is worthy of clinical application. |
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