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Previous issue date: 2017 === A abdu??o do joelho durante atividades din?micas realizadas em cadeia cin?tica fechada ?
considerada o principal mecanismo envolvido nas les?es n?o traum?ticas do joelho. A
abdu??o do joelho est? relacionada ao aumento da adu??o do quadril, da rota??o medial do
f?mur e da prona??o do p?, tais altera??es cinem?ticas podem ser influenciadas por altera??es
de alinhamento estrutural, amplitude de movimento e for?a muscular. Especificamente, o
varismo excessivo do antep?, a diminui??o da for?a muscular de rotadores laterais de quadril
e o aumento da amplitude de movimento passiva de rota??o medial do quadril podem
contribuir para o aumento da prona??o do p? e da rota??o medial da t?bia e f?mur, o que
consequentemente pode contribuir para a abdu??o do joelho em cadeia fechada. Portanto,
entender como estes fatores em conjunto interagem e influenciam a abdu??o do joelho
permite desenvolvimento de estrat?gias de preven??o e reabilita??o mais eficientes. O
objetivo da presente disserta??o foi investigar a influ?ncia do alinhamento do p?, torque
muscular de rotadores laterais do quadril e amplitude de movimento passiva em rota??o
medial do quadril na cinem?tica do joelho no plano frontal durante o agachamento unipodal.
Quarenta e um indiv?duos participaram do estudo, sendo avaliados nos testes de torque
isom?trico de rotadores laterais do quadril (TRLQ), amplitude de movimento (ADM) passiva
de rota??o medial (RM) do quadril, alinhamento perna-antep? (APA) e avalia??o da
cinem?tica do joelho no plano frontal durante o agachamento unipodal atrav?s do sistema de
an?lise do movimento em 3D. A ?rvore de classifica??o e regress?o (Classification and
Regression Tree - CART) foi utilizada para identificar os fatores e intera??es que est?o
associados ao movimento do joelho no plano frontal. A curva receiver operating
characteristic (ROC) foi usada para determinar a acur?cia do modelo desenvolvido pela
CART. Finalmente, utilizou-se a raz?o de preval?ncia (RP) para identificar a for?a de
associa??o das intera??es indicadas em cada nodo terminal da ?rvore com o desfecho. Os
resultados revelaram que 14 indiv?duos (93,3%) classificados com abdu??o do joelho
apresentaram menores valores de TRLQ (entre 0,26 e 0,47) e maiores valores de APA
(>10,11?), com RP igual a 3,03. O modelo desenvolvido pela CART obteve acur?cia
adequada (91,5% (IC 95%= 82,7-100) p < 0.0001), indicando como predi??o correta 81,8%
de indiv?duos com abdu??o de joelho e 94,7% de indiv?duos com adu??o do joelho. Concluise
que a abdu??o do joelho ? influenciada e depende da intera??o entre TRLQ e APA, sendo
assim, indiv?duos com menores valores de TRLQ e maiores APA apresentam abdu??o do
joelho. === Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Reabilita??o e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. === The knee abduction during dynamic activities in closed kinetic chain is considered the main
mechanism involved in non-traumatic knee injuries. Knee abduction is related to the increase
in hip adduction, femur medial rotation and foot pronation. These kinematic changes can be
influenced by modifications on structural alignment, range of motion and muscular strength.
Specifically, the excess of forefoot varus, reduction strength of in the lateral hip rotators and
increased passive hip medial rotation can contribute to a higher degree of foot pronation and
medial rotation of tibia and femur, which may contribute to the abduction of the closed-chain
knee. Therefore the understanding of how these factors interact to influence the keen
abduction permits the development of prevention strategies and a more efficient
rehabilitation. The aim of the study was to investigate the influence of foot alignment, hip
lateral rotator torque and passive hip medial rotator range of motion on frontal plane knee
kinematic during single leg squat. Forty one subjects participated in this study. They were
tested on the hip lateral rotator isometric torque test (HLIT), passive range of motion (ROM)
of hip medial rotator (MR), shank-forefoot alignment (SFA) and were assessed on the frontal
plane knee kinematics during single leg squat using a 3D movement analysis system. The
Classification and Regression Tree ? CART was used to identify factors and interaction that
are associated to the occurrence of knee abduction. The receiver operation characteristic curve
(ROC) was used to calculate the accuracy of the model developed by the CART. Finally,
prevalence ratio (PR) was used to identify the strength of the association of the interactions
indicated at each terminal node with the outcome. The results revealed that 14 subjects
(93.3%) classified with knee abduction present lower HLIT values (between 0.26 and 0.47)
and higher SFA values (>10.11?, PR=3.03). The model developed by CART had an adequate
accuracy (91.5% (IC 95%= 82.7-100) p < 0.0001), indicating a correct prediction of 81.8% of
the subjects with knee abduction and 94.7% of the subjects with knee adduction. In
conclusion the knee abduction is influenced and depends on the interaction between HLIT
and SFA. Subjects with a lower HLIT and higher FSA present knee abduction.
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