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Abstract：
To examine the effect of anterior cruciate ligament (ACL) reconstruction on spinal-reflex and corticospinal excitability of the quadriceps muscle.
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.
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.
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.
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.
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.
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.
摘要：
探讨前交叉韧带(ACL)重建术对股四头肌脊髓反射和皮质脊髓兴奋性的影响。
进行了全面的电子数据库搜索，以确定客观测量霍夫曼反射与肌肉反应比率的研究，电机阈值,ACL重建后的运动诱发电位。使用随机效应荟萃分析模型计算汇总标准化平均差(SMD)。
共有13项研究符合分析条件。与健康对照腿相比，重建腿和非重建腿的霍夫曼反射对肌肉反应的比率均显着较高（SMD=0.28，95％置信区间（95CI）：0.08-0.49，p=0.006和SMD=0.22，95CI：0.04-0.40，p=0.016），但两腿之间没有差异（SMD=0.10，95CI：-0.01至0.21，p=0.078）。与健康对照的腿相比，重建腿（SMD=0.76，95CI：0.40-1.12，p<0.001）和非重建腿（SMD=0.47，95CI：0.00-0.95，p=0.049）的运动阈值均显着较高。与非重建腿相比，重建腿的运动阈值也更高（SMD=0.20，95CI：0.06-0.34，p=0.005）。这些变化伴随着股四头肌力量的双侧降低(ACL重建:SMD=-0.78,95CI:-1.07至-0.49,p<0.001;非重建:SMD=-0.32,95CI:-0.63至-0.01,p=0.042)和股四头肌自愿性激活(ACL重建:SMD=-0.73,95CI:-0.97至-0.50,p<0.001;非重建:
ACL重建后，脊髓反射途径的兴奋性增加，皮质脊髓途径的兴奋性降低。这些变化伴随着股四头肌力量和自愿激活的减少，建议康复干预措施应着重于使神经通路的兴奋性正常化，以有效解决ACL重建后的股四头肌功能障碍。
进行了全面的电子数据库搜索，以确定客观测量霍夫曼反射与肌肉反应比率的研究，电机阈值,ACL重建后的运动诱发电位。使用随机效应荟萃分析模型计算汇总标准化平均差(SMD)。
共有13项研究符合分析条件。与健康对照腿相比，重建腿和非重建腿的霍夫曼反射对肌肉反应的比率均显着较高（SMD=0.28，95％置信区间（95CI）：0.08-0.49，p=0.006和SMD=0.22，95CI：0.04-0.40，p=0.016），但两腿之间没有差异（SMD=0.10，95CI：-0.01至0.21，p=0.078）。与健康对照的腿相比，重建腿（SMD=0.76，95CI：0.40-1.12，p<0.001）和非重建腿（SMD=0.47，95CI：0.00-0.95，p=0.049）的运动阈值均显着较高。与非重建腿相比，重建腿的运动阈值也更高（SMD=0.20，95CI：0.06-0.34，p=0.005）。这些变化伴随着股四头肌力量的双侧降低(ACL重建:SMD=-0.78,95CI:-1.07至-0.49,p<0.001;非重建:SMD=-0.32,95CI:-0.63至-0.01,p=0.042)和股四头肌自愿性激活(ACL重建:SMD=-0.73,95CI:-0.97至-0.50,p<0.001;非重建:
ACL重建后，脊髓反射途径的兴奋性增加，皮质脊髓途径的兴奋性降低。这些变化伴随着股四头肌力量和自愿激活的减少，建议康复干预措施应着重于使神经通路的兴奋性正常化，以有效解决ACL重建后的股四头肌功能障碍。
