Gobbi Alberto, Francisco Ramces
Orthopaedic Arthroscopic Surgery International (O.A.S.I.), 24 Via Amadeo G.A., 20133 Milan, Italy.
Knee Surg Sports Traumatol Arthrosc. 2006 Oct;14(10):1021-8. doi: 10.1007/s00167-006-0050-9. Epub 2006 Feb 22.
In athletes, anterior cruciate ligament (ACL) reconstruction is recommended after injury to restore the normal knee function and allow subsequent return to sport. Successful ACL reconstruction with patellar tendon (PT) and hamstring tendon (HT) grafts combined with a well-structured rehabilitation program could bring athletes back to their previous level of sport activities. We prospectively followed-up 100 athletes who underwent ACL reconstruction with either PT (n=50) or HT grafts (n=50). Evaluation was done pre-operatively and post-operatively (3, 6, 12, and 24 months) using International Knee Documentation Committee (IKDC), Lysholm, Noyes, and Tegner scales. Subjective assessment numeric evaluation (SANE), knee activity rating scale (Marx) and a psychological profile questionnaire (psychovitality) were also utilized. Objective evaluations included isokinetic tests and computerized knee motion analysis. Data gathered were statistically analyzed using the Mann-Whitney non-parametric U-test. Among the 100 patients who have undergone ACL reconstruction, 65% returned to the same level of sports, 24% changed sports and 11% ceased sport activities. No significant difference (P>0.05) in outcome between PT and HT grafts were observed. No significant differences (P>0.05) were noted between athletes who "returned" to their previous sport and those who "did not return" to sports at the same level when using the IKDC, Lysholm, Noyes, and Tegner knee evaluation scales. However, significant difference was observed with the knee scores obtained by those who returned and those who completely ceased participation in sport activities. Computerized laxity test revealed that 90% of these patients have less than 3 mm side-to-side difference with no significant difference between HT and PT groups. Patients who "returned to sports" obtained significantly better scores with the Marx scale (P=0.001) and the psychovitality questionnaire (P=0.001) than those who did not. Conventional knee scales including IKDC, Lysholm, Noyes, and Tegner remain as reliable means of evaluating outcome of ACL reconstruction. However, the data obtained from these are not sufficient to determine which among the patients who had knee reconstruction can successfully return to sport. The use of the Marx knee activity rating scale and the evaluation of the athletes' psychological profile are additional scales that can be useful in determining which among the patients treated have a better chance of returning to their pre-injury activity levels.
对于运动员，前交叉韧带（ACL）损伤后建议进行重建手术，以恢复膝关节正常功能并使其能够继续参加运动。采用髌腱（PT）和腘绳肌腱（HT）移植物成功进行ACL重建，并结合精心设计的康复计划，可使运动员恢复到先前的运动水平。我们对100例接受ACL重建的运动员进行了前瞻性随访，其中50例采用PT移植物，50例采用HT移植物。术前及术后（3、6、12和24个月）使用国际膝关节文献委员会（IKDC）、Lysholm、Noyes和Tegner量表进行评估。还采用了主观评估数字评价（SANE）、膝关节活动评分量表（Marx）和心理状况问卷（心理活力）。客观评估包括等速测试和计算机化膝关节运动分析。收集的数据采用Mann-Whitney非参数U检验进行统计学分析。在100例接受ACL重建的患者中，65%恢复到相同运动水平，24%更换了运动项目，11%停止了体育活动。PT和HT移植物在疗效上无显著差异（P>0.05）。使用IKDC、Lysholm、Noyes和Tegner膝关节评估量表时，“恢复”到先前运动水平的运动员与未恢复到相同运动水平的运动员之间无显著差异（P>0.05）。然而，恢复运动的患者与完全停止参加体育活动的患者在膝关节评分上存在显著差异。计算机化松弛度测试显示，这些患者中有90%的左右差异小于3mm，HT组和PT组之间无显著差异。“恢复运动”的患者在Marx量表（P=0.001）和心理活力问卷（P=0.001）上的得分显著高于未恢复运动的患者。包括IKDC、Lysholm、Noyes和Tegner在内的传统膝关节量表仍然是评估ACL重建疗效的可靠方法。然而，从这些量表获得的数据不足以确定哪些接受膝关节重建的患者能够成功恢复运动。Marx膝关节活动评分量表的使用以及对运动员心理状况的评估是另外两种有助于确定哪些接受治疗的患者有更好机会恢复到受伤前活动水平的量表。
