Análise dos efeitos agudos da cirurgia de reconstrução do ligamento cruzado anterior com enxerto de tendão flexor, no equilíbrio e na ativação muscular e cinemática do membro inferior

Abstract

Anterior Cruciate Ligament (ACL) rupture is a very common lesion in the orthopedic and sports context and among the techniques developed for ACL reconstruction, the technique with autologous grafting of the hamstring tendon is highlighted. Although there is an abundant literature regarding ACL reconstruction surgery and its results in the medium and long term, there is little information on the immediate repercussions of this procedure in relation to the balance, muscular activation, mainly of the proximal musculature of the hip, and kinematic analysis of the lower limbs. Thus, the aim of this study was to analyze the acute postoperative effects of ACL reconstruction surgery with hamstring tendon graft through Balance and muscle activation and kinematics of lower limbs. The selected sample consisted of 14 men (31 ± 9 years) who underwent ACL reconstruction surgery with a knee flexor tendon graft. The volunteers performed a simultaneous evaluation of the lower limb kinematics, electromyographic evaluation of the gluteus maximus, gluteus medius, vastus medialis, vastus lateralis, semitendinosus, biceps thigh and gastrocnemius medial portion and evaluation of balance by baropodometric during mini-squatting. The evaluation took place in two different moments: one pre-surgical evaluation and the other 15 days after ACL reconstruction surgery and in two sensory conditions: with open eyes and with closed eyes. Intragroup comparisons (pre-X post) were performed for each limb (injured and healthy), using Student's t-tests for dependent samples or the Wilcoxon test, according to the distribution of the data of each group, considering α = 5% . In relation to the kinematic evaluation, only the increase of hip adduction on the healthy side (p = 0.030) and decreased of hip abduction on the injured side (p = 0.008) after reconstruction were observed. There was reduction of muscle activation (gross data) for the gluteus medius (p = 0.023), vastus medialis (p = 0.002) vastus lateralis (p = 0.002) biceps femuris (0.043) of the injured limb during the mini squat with open eyes (P = 0.039), vastus medialis (p = 0.002) vastus lateralis (p = 0.004) biceps femuris (0.019) and medial gastrocnemius portion (p = 0.007) of the injured limb during mini-squatting with eyes closed. After normalization of the data, the maximal voluntary isometric contraction (MVIC) showed increased activation during the miniagachamento with open and closed eyes for the muscles: gluteus maximus healthy side (p = 0.011) (p = 0.005), gluteus medius healthy side (P = 0.025) and injured side (p = 0.011) (p = 0.011), semitendinosus injured side (p = 0.002) (p = 0.001), biceps femuris injured side (p=0.046) and medial gastrocnemius lesioned side (p = 0.004) (p = 0.004) and decreased activation of the vastus medialis injured side (p = 0.016) (p = 0.021). During the electromyographic evaluation of the MVIC, there was a reduction in the activation of the gluteus medius (p = 0.013), vastus medialis (p = 0.035) semitendinosus (p = 0.001), biceps femuris (p <0.001) and medial gastrocnemius portion (p=0.001) of the injured side. In relation to the balance, there was an increase in the area of displacement of the center of pressure of the injured limb with open eyes (p = 0.004), as well as a decrease in the mass distribution on the injured limb (p = 0.001) and, consequently the increase healthy limb (p = 0.001). Considering the above, ACL reconstruction surgery with hamstring tendon can promote immediate changes in kinematics, muscle activation of the limb, as well as alter the balance strategies of the individuals submitted to this procedure.