Fitzgerald G K, Axe M J, Snyder-Mackler L
Department of Physical Therapy, School of Rehabilitation and Health Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA. kfitzger+@pitt.edu.
Phys Ther. 2000 Feb;80(2):128-40.
Treatment techniques involving perturbations of support surfaces may induce compensatory muscle activity that could improve knee stability and increase the likelihood of returning patients to high-level physical activity. The purpose of this study was to determine the efficacy of augmenting standard nonoperative anterior cruciate ligament (ACL) rehabilitation programs with a perturbation training program.
Twenty-six patients with acute ACL injury or ruptures of ACL grafts participated in the study. Subjects had to have a unilateral ACL injury, be free of concomitant multiple ligament or meniscal damage requiring surgical repair, and pass a screening examination designed to identify patients who had the potential to return to high-level physical activity with nonoperative treatments. Subjects also had to be regular participants in level I activities (eg, soccer, football, basketball) or level II activities (eg, racquet sports, skiing, construction work).
Subjects were randomly assigned to either a group that received a standard rehabilitation program (standard group) or a group that received the standard program augmented with a perturbation training program (perturbation group). Treatment outcome was determined from scores on the Knee Outcome Survey's Activities of Daily Living Scale (ADLS) and Sports Activity Scale, a global rating of knee function, scores on a series of single-limb hop tests, measurements of maximum isometric quadriceps femoris muscle force output, and the group frequency of unsuccessful rehabilitation. Unsuccessful rehabilitation was defined as the occurrence of an episode of giving way of the knee or failure to maintain the functional status of a rehabilitation candidate on retesting.
More subjects had unsuccessful rehabilitation in the standard group compared with the perturbation group. There was a within-group x time interaction for the ADLS, global rating of knee function, and crossover hop test scores. These scores decreased from posttraining to the 6-month follow-up for the standard group.
Although both the standard program and the perturbation training program may allow subjects to return to high-level physical activity, the perturbation training program appears to reduce the risk of continued episodes of giving way of the knee during athletic participation and allows subjects to maintain their functional status for longer periods.
涉及支撑面扰动的治疗技术可能会诱发代偿性肌肉活动，这有助于改善膝关节稳定性，并增加患者恢复高水平体育活动的可能性。本研究的目的是确定在标准的非手术前交叉韧带（ACL）康复计划中增加一个扰动训练计划的效果。
26例急性ACL损伤或ACL移植物断裂的患者参与了本研究。受试者必须为单侧ACL损伤，无需要手术修复的合并多条韧带或半月板损伤，并且通过一项筛选检查，该检查旨在识别有可能通过非手术治疗恢复高水平体育活动的患者。受试者还必须是I级活动（如足球、橄榄球、篮球）或II级活动（如球拍运动、滑雪、建筑工作）的常规参与者。
受试者被随机分为两组，一组接受标准康复计划（标准组），另一组接受在标准计划基础上增加扰动训练计划的方案（扰动组）。治疗结果通过膝关节结果调查日常生活活动量表（ADLS）和体育活动量表的得分、膝关节功能的整体评分、一系列单腿跳测试的得分、股四头肌最大等长肌力输出的测量以及康复失败的组频率来确定。康复失败定义为膝关节出现打软腿事件，或在重新测试时未能维持康复候选人的功能状态。
与扰动组相比，标准组中康复失败的受试者更多。ADLS、膝关节功能整体评分和交叉跳测试得分存在组内x时间交互作用。这些分数在标准组中从训练后到6个月随访时有所下降。
尽管标准计划和扰动训练计划都可能使受试者恢复高水平体育活动，但扰动训练计划似乎能降低运动参与期间膝关节持续出现打软腿的风险，并使受试者在更长时间内维持其功能状态。
