How does anterior cruciate ligament reconstruction affect the functioning of the brain and spinal cord?A systematic review with meta-analysis  

作　　者：Kazandra M.Rodriguez Riann M.Palmieri-Smith Chandramouli Krishnan 

机构地区：[1]School of Kinesiology,University of Michigan,Ann Arbor,MI 48109,USA [2]Department of Orthopaedic Surgery,Michigan Medicine,Ann Arbor,MI 48109,USA [3]Department of Physical Medicine and Rehabilitation,Michigan Medicine,Ann Arbor,MI 48108,USA [4]Biomedical Engineering,University of Michigan,Ann Arbor,MI 48109,USA [5]Michigan Robotics Institute,University of Michigan,Ann Arbor,MI 48109,USA

出　　处：《Journal of Sport and Health Science》2021年第2期172-181,共10页运动与健康科学（英文）

基　　金：the National Institutes of Health(Grant No.R21-HD092614).

摘　　要：Objective:To examine the effect of anterior cruciate ligament(ACL)reconstruction on spinal-reflex and corticospinal excitability of the quadriceps muscle.Methods:A comprehensive electronic database search was performed to identify studies that objectively measured Hoffmann reflex to muscle response ratio,motor threshold,and motor evoked potentials after ACL reconstruction.Pooled standardized mean differences(SMDs)were computed using a random effects meta-analysis model.Results:A total of 13 studies were eligible for analysis.The Hoffmann reflex to muscle response ratio was significantly higher on both the reconstructed and non-reconstructed legs when compared with the healthy control leg(SMD=0.28,95%confidence interval(95%CI):0.08-0.49,p=0.006 and SMD=0.22,95%CI:0.04-0.40,p=0.016,respectively)but did not differ between legs(SMD=0.10,95%CI:-0.01 to 0.21,p=0.078).The motor threshold was significantly higher on both the reconstructed(SMD=0.76,95%CI:0.40-1.12,p<0.001)and non-reconstructed legs(SMD=0.47,95%CI:0.00-0.95,p=0.049)when compared with the legs of healthy controls.The reconstructed leg also had a higher motor threshold when compared with the non-reconstructed leg(SMD=0.20,95%CI:0.06-0.34,p=0.005).These changes were paralleled by bilateral reductions in quadriceps strength(ACL reconstructed:SMD=-0.78,95%CI:-1.07 to-0.49,p<0.001;non-reconstructed:SMD=-0.32,95%CI:-0.63 to-0.01,p=0.042)and quadriceps voluntary activation(ACL reconstructed:SMD=-0.73,95%CI:-0.97 to-0.50,p<0.001;non-reconstructed:SMD=-0.55,95%CI:-0.82 to-0.27,p<0.001)when compared with healthy controls.Conclusion:There is increased excitability of the spinal-reflex pathways and reduced excitability of the corticospinal pathways following ACL reconstruction.These changes are paralleled by reductions in quadriceps strength and voluntary activation,suggesting that rehabilitation interventions should focus on normalizing the excitability of neural pathways to effectively address quadriceps dysfunction after ACL reconstruction.

关 键 词：ACLR Cortical excitability H-REFLEX Transcranial magnetic stimulation TMS 

分 类 号：G804.2[文化科学—运动人体科学] R873[文化科学—体育学]