Fitzgerald G K, Axe M J, Snyder-Mackler L
Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA 15260, USA. kfitzger+@pitt.edu
Knee Surg Sports Traumatol Arthrosc. 2000;8(2):76-82. doi: 10.1007/s001670050190.
This report describes the development and current use of decision-making criteria for returning patients to high-level physical activity with nonoperative management of anterior cruciate ligament ruptures, and presents the results of treatment for patients who met our criteria as candidates for nonoperative rehabilitation and attempted to return to high-level physical activity with nonoperative management. The screening examination consists of four one-legged hop tests, the incidence of knee giving-way, a self-report functional survey, and a self-report global knee function rating. We screened 93 consecutive patients with acute unilateral anterior cruciate ligament rupture, classifying them as either candidates (n = 39, 42%) or noncandidates (n = 54, 58%) for nonoperative management. Of the 39 rehabilitation candidates 28 chose nonoperative management and returned to preinjury activity levels, 22 of whom (79%) returned to preinjury activity levels without further episodes of instability or a reduction in functional status. No patient sustained additional articular or meniscal damage as a result of rehabilitation or return to activity. The decision-making scheme described in this study shows promise in determining who can safely postpone surgical reconstruction and temporarily return to physically demanding activities. Continued study to refine and further validate the decision-making scheme is recommended.
本报告描述了用于让前交叉韧带断裂患者通过非手术治疗恢复高水平体育活动的决策标准的制定及当前应用情况，并呈现了符合我们非手术康复标准且尝试通过非手术治疗恢复高水平体育活动的患者的治疗结果。筛查检查包括四项单腿跳跃测试、膝关节打软腿的发生率、一份自我报告功能调查问卷以及一份自我报告的整体膝关节功能评分。我们对93例连续的急性单侧前交叉韧带断裂患者进行了筛查，将他们分为非手术治疗的候选者（n = 39，42%）或非候选者（n = 54，58%）。在39例康复候选者中，28例选择了非手术治疗并恢复到伤前的活动水平，其中22例（占79%）恢复到伤前活动水平，且没有进一步的不稳定发作或功能状态下降。没有患者因康复或恢复活动而遭受额外的关节或半月板损伤。本研究中描述的决策方案在确定谁可以安全地推迟手术重建并暂时恢复到对身体要求较高的活动方面显示出前景。建议继续进行研究以完善并进一步验证该决策方案。
