Key words: Anti-Gravity Treadmill Training; Anterior Cruciate Ligament Reconstruction; Early Rehabilitation; Clinical Rehabilitation Effect
ABSTRACT
Objective: To observe the efficacy of anti-gravity treadmill training in early rehabilitation after anterior cruciate ligament reconstruction, to explore the influence of anti-gravity treadmill training combined with conventional rehabilitation training on relevant indicators, and to provide scientific theoretical basis for the application of anti-gravity treadmill training in early rehabilitation after anterior cruciate ligament reconstruction.
Methods: A total of 54 patients who underwent anterior cruciate ligament reconstruction were selected from the Rehabilitation Medicine Clinic, orthopedic Clinic, Sports Medicine Center and the Medical Consortium of Zhongda Hospital from December 1, 2022. All patients signed informed consent forms and were numbered. The patients were randomly divided into three groups: Group A (conventional treatment group, 18 patients), group B1 (conventional walking training group, 18 patients) and group B2 (anti-gravity treadmill training group, 18 patients). All patients in the three groups were given routine basic rehabilitation training, 3 times a week. Group A only received routine basic rehabilitation training, group B1 received routine walking training on the basis of routine basic rehabilitation training, and group B2 received anti-gravity treadmill training on the basis of routine basic rehabilitation training. Each group was treated three times a week for five weeks. Knee motor function (IKDC-2000 knee function score, lysholm score), ultrasonic morphology (thickness, pinniate Angle, cross-sectional area) of the rectus femoris, proprioception of the knee joint (recurrence deviation of the knee joint 0° ~ 40°, recurrence deviation of the knee joint 41° ~ 80°), stability of the knee joint (KT-1000 measurements), and quadriceps femoris Each index of muscle recruitment degree (vastus medialis AEMG, rectus femoris AEMG, vastus lateralis AEMG) was evaluated by rehabilitation treatment, and the treatment cycle was 5 weeks. The first data were collected before the first treatment, and the second data were collected after the treatment cycle. The collected experimental data were sorted out and analyzed, and finally discussed.
Research results: Before the treatment, The knee motion function (IKDC-2000 knee function score and lysholm score), ultrasonic morphology of the rectus femoris muscle (thickness, pinniate Angle, cross-sectional area), proprioception of the knee joint (recurrence deviation of the knee joint from 0° to 40°, recurrence deviation of the knee joint from 41° to 80°), and stability of the knee joint (KT-1000 measurements) were not clear in the three groups The difference was significant (P>0.05). After 5 weeks, knee motor function (IKDC-2000 knee function score and lysholm score) were significantly different among the three groups compared with before treatment (P<0.05). There were no significant differences between group B1 and group A (P>0.05), there were significant differences between group B2 and group A (P<0.05), there were significant differences between group B2 and group B1 (P<0.05); The ultrasonic morphology (thickness, pinnate Angle and cross-sectional area) of the rectus femoris muscle in the three groups were significantly different compared with that before treatment (P<0.05). There were no significant differences among the three groups (P>0.05). Knee proprioception (recurrence deviation of knee 0° ~ 40° and 41° ~ 80°) was significantly different among the three groups compared with before treatment (P<0.01). There were no significant differences between B1 and group A (P>0.05), there were significant differences between B2 and group A (P<0.05), and there were significant differences between B2 and group B1 (P<0.05). Knee stability (measured by KT-1000) was significantly different among the three groups compared with that before treatment (P<0.01). There were no significant differences between B1 and group A (P>0.05), there were significant differences between B2 and group A (P<0.05), and there were significant differences between B2 and group B1 (P<0.05). The degree of quadriceps muscle recruitment (femoris medialis, rectus femoris and lateralis femoris AEMG) in anti-gravity treadmill training group was significantly different from that before treatment (P<0.05).
Conclusion: (1) 5 weeks of routine basic rehabilitation training, routine walking training and anti-gravity treadmill training can effectively improve knee motor function, ultrasonic morphology of the rectus femoris muscle and proprioception of the knee joint. (2) Compared with the conventional treatment group and the conventional walking training group, the anti-gravity treadmill training group had better clinical efficacy in the knee motor function, knee proprioception and knee stability, but the ultrasonic morphology of the rectus femoris muscle after treatment was no different from the other two groups. (3) Anti-gravity treadmill training can improve the degree of quadriceps muscle recruitment in patients with ACL reconstruction.
Article cited in：[1]崔军. 反重力跑台训练对前交叉韧带重建术后早期康复的疗效研究[D].南京体育学院,2023.DOI:10.27247/d.cnki.gnjtc.2023.000160.
Article link：反重力跑台训练对前交叉韧带重建术后早期康复的疗效研究 – 中国知网 (cnki.net)
Introduction
The anterior cruciate ligament (ACL) is an intracapsular ligament in the knee joint. Its main function is to prevent the tibia from moving forward and maintain the stability of the knee joint and the mechanical balance of the lower limbs. Knee ACL injuries account for 80% of knee ligament injuries. ACL rupture results in loss of knee joint stability and disordered load conduction, leading to knee joint instability and pain when patients walk, and increasing the long-term incidence of osteoarthritis. Early surgical reconstruction of stability is currently a recognized treatment method, but postoperative biomechanical changes in the lower limbs often lead to abnormal gait, specifically manifested as quadriceps inhibition, limited weight-bearing, and compensatory movements of the hip and ankle joints. It further causes knee joint pain, limited movement, proprioceptive impairment, poor walking stability, decreased walking ability and other problems, seriously affecting the patient’s daily life activities. It follows that an effective rehabilitation program after ACL reconstruction is necessary. The anti-gravity treadmill training system is a type of weight-reducing support walking training system. It can provide patients with accurate, safe and effective weight-bearing in the early stage, simulate normal walking training scenarios, and provide effective exercise training intensity. The device uses a special air pressure control system to change the force of gravity felt by the lower limbs during walking training. The device is capable of providing up to 80% of body weight support in 1% increments, allowing for a pain-free, systematically graded rehabilitation exercise program based on the user’s specific needs. The anti-gravity treadmill training system is highly safe and simple to operate, but does not place high functional requirements on patients. It can increase walking distance while maintaining normal walking, and perform walking and running activities without causing changes in ankle and knee joint mobility. , and effectively reduce the impact on the knees when walking. This training method demonstrates the effectiveness of early rehabilitation in reducing the forces transmitted to the knee by adjusting the load. Therefore, this article focuses on relevant clinical indicators such as knee joint motor function, rectus femoris ultrasound morphology, knee joint proprioception, stability, and quadriceps activation level, and compares the anti-gravity treadmill training group with the conventional training group and the conventional walking training group. The clinical efficacy of anti-gravity treadmill training in early rehabilitation intervention after anterior cruciate ligament reconstruction will be discussed based on the results. Current research on anti-gravity treadmill training after ACL reconstruction is mostly focused on the impact of patients’ postoperative pain and gait, and there is no study on the impact of early postoperative weight-bearing exercise intervention on knee joint movement function, quadriceps activation level, femoral function, etc. Relevant research on rectus muscle morphology, proprioception, and knee joint stability efficacy. Based on previous research, we came up with the idea of this experiment to explore the effect of anti-gravity treadmill training on the early postoperative period after ACL reconstruction. If the final results confirm the hypothesis of this article, then anti-gravity treadmill training will be more widely used in clinical applications and can be introduced into the field of neurological rehabilitation.
Anti-Gravity Treadmill Training Overview
The anti-gravity treadmill training system is a type of weight loss support walking training system and is also a representative method of lower limb positive pressure (LBPP) treadmill. The device uses a special air pressure control system to change the force of gravity felt by the lower limbs during walking training. The device is capable of providing up to 80% of body weight support in 1% increments, allowing for a pain-free, systematically graded rehabilitation exercise program based on the user’s specific needs. Compared with the suspended weight-loss system (the patient is lifted up with a sling on the treadmill, and the central part forms a concentrated pressure point), the force of the anti-gravity treadmill training system acts close to the position of the body’s center of gravity, and the air bag can lift the patient’s waist Wrapping can improve the safety of patient training while also reducing the patient’s sense of tension; the weight support provided by this device is even and non-viscous resistance, making the patient’s lower limb movements more free and in line with physiological movement patterns, and can promote the regeneration of neuromuscular function. educate. In addition, the system is very easy to use, has high safety and has low functional requirements for patients. In addition, it can also promote venous return during walking, thereby significantly reducing the heart rate. Robert K Eastlack used an antigravity treadmill for patients in the early stages of ACL reconstruction and reported pain reduction and safe recovery. Anti-gravity treadmill training can increase walking distance while maintaining normal walking, enable walking and running activities without causing changes in ankle and knee joint mobility, and effectively reduce the impact on the knees during walking. This training method demonstrates the effectiveness of early rehabilitation in reducing the forces transmitted to the knee by adjusting the load. Additionally, using an anti-gravity treadmill for muscle strengthening and aerobic exercise can improve walking and dynamic balance while maintaining the same dynamic movements as normal walking and reducing stress on the musculoskeletal system. Therefore, anti-gravity treadmill training is an intervention to prevent quadriceps atrophy and enhance muscle strength in patients after ACL reconstruction. In a study on anti-gravity treadmill training and electromyography, Junjie Liang et al. found that the root mean square (RMS) of the rectus femoris, semitendinosus, and biceps femoris after treatment in patients with knee osteoarthritis. The values have improved to varying degrees compared with before treatment. Previous studies have also found that anti-gravity treadmill training has a positive impact on knee joint muscle function and can effectively improve knee joint gait patterns and muscle strength. Similarly, the anti-gravity treadmill has a good user experience. The waist-sealed design provides patients with sufficient security. The strap-less design can also disperse the pressure well to the buttocks and thighs, so that the perineum will not suffer. Large pressure stimulation can bring a very comfortable feeling to the patient. This positive experience can create good prerequisites for patients’ subsequent rehabilitation intervention. Early and accurate weight-bearing walking training can also increase patients’ confidence and positively guide patients’ rehabilitation treatment.
Discussion and analysis
Anterior cruciate ligament reconstruction (ACLR) is a recognized treatment method to restore the stability of the anterior cruciate ligament (ACL) after initial injury. However, postoperative biomechanical changes in the lower limbs often lead to abnormal gait, specifically manifested as quadriceps inhibition. , limited weight-bearing, and compensatory movements of the hip and ankle joints. It further causes knee joint pain, limited movement, proprioceptive impairment, poor walking stability, decreased walking ability and other problems, seriously affecting the patient’s daily life activities. An effective rehabilitation program after ACL reconstruction is necessary to restore the comprehensive function of the joint through rehabilitation treatment and allow the patient to return to the pre-injury level of motion and reduce the risk of re-injury. Commonly used interventions include vibration training, open chain training, closed chain training, electrical stimulation, postoperative braces and hydrotherapy. Rehabilitation treatment after ACL reconstruction has always been a hot research topic. Anti-gravity treadmill training can help patients perform walking training as soon as possible after surgery. The system regulates exercise intensity by controlling the weight loss ratio and running speed, and can effectively buffer the knee joint pressure. Weight-bearing is limited in the early postoperative period after ACL reconstruction, and low-intensity muscle contraction caused by lower limb weight-bearing leads to decreased muscle activity. At the same time, the quadriceps muscles are unable to bear the weight of the body, resulting in muscle atrophy and weakness. The weakening of the lower limb muscles also reduces balance. Anti-gravity treadmill training can provide safe and accurate weight support in the early postoperative period and create favorable weight-bearing conditions, thereby providing patients with more natural and physiological movements and conducive to neuromuscular re-education. Previous studies have also found that anti-gravity treadmill training has a positive impact on knee joint muscle function, which can effectively improve knee joint gait patterns and muscle strength. The purpose of this study is to discuss the following aspects: in early rehabilitation after anterior cruciate ligament reconstruction, whether conventional basic rehabilitation training combined with anti-gravity treadmill training has a better effect than conventional basic rehabilitation training alone; anti-gravity treadmill training Is the training more effective than regular walking training? Therefore, this article will combine the experimental results of various clinical monitoring indicators to comprehensively discuss the efficacy of anti-gravity treadmill training in early rehabilitation of anterior cruciate ligament reconstruction.
In conclusion
(1) 5 weeks of routine basic rehabilitation training, routine walking training and anti-gravity treadmill training can effectively improve knee joint movement function, rectus femoris ultrasound morphology and knee joint proprioception. (2) Compared with the conventional treatment group and the conventional walking training group, the anti-gravity treadmill training group had better clinical effects on knee joint movement function, knee joint proprioception and knee joint stability, but the rectus femoris muscle after treatment The ultrasound morphology was no different from the other two groups. (3) Anti-gravity treadmill training can improve the degree of quadriceps muscle recruitment in patients with anterior cruciate ligament reconstruction.