Herrington Lee, Fowler Elizabeth
School of Healthcare Professionals, University of Salford, Allerton Annexe, Frederick Road, Salford, Greater Manchester, M6 6PU, UK.
Knee. 2006 Aug;13(4):260-5. doi: 10.1016/j.knee.2006.02.010. Epub 2006 Jun 27.
Rupture of the anterior cruciate ligament (ACL) results in increased tibiofemoral laxity in the knee, thereby ultimately resulting in knee instability and dysfunction. However, ACL rupture does not automatically infer functional impairment and instability as confirmed by the ACL deficient (ACLD) coper, who can resume pre-morbid activity levels. Alternatively, an authentic ACLD non-coper is unable to return to pre-injury levels of activity due to repeated incidents of giving-way. Little is known as to the contributory factors, which allows copers dynamic stability and render non-copers functionally impaired. This systematic literature review aims to examine the evidence presented by relevant trials in order to identify measurement tools, which could differentiate ACLD copers and non-copers. A literature search found nine trials; four adhered to the inclusion criteria of this review. Consensus was achieved within the studies that laxity measurements and IKDC ratings are incapable of distinguishing the functional status of the ACLD patient. Alternatively, Lysholm, KOS-Sport, KOS-ADL and Global Knee Function Rating Scores were regarded as capable of discriminating between ACLD copers and non-copers. Disagreement existed as to the efficacy of the Quadriceps Index and the single leg hop in categorising the ACLD patient according to function level. It was concluded that no single measurement tool is sufficient in determining the functional status of the ACLD individual. Consequently, a collaboration of tests is recommended, specifically incorporating the KOS-Sport, Global Knee Function Rating, hop tests and Quadriceps Index.
前交叉韧带(ACL)断裂会导致膝关节胫股关节松弛增加,最终导致膝关节不稳定和功能障碍。然而,正如ACL缺陷(ACLD)代偿者所证实的那样,ACL断裂并不一定会导致功能损害和不稳定,这些代偿者能够恢复到病前的活动水平。相反,真正的ACLD非代偿者由于反复出现膝关节发软的情况,无法恢复到受伤前的活动水平。关于导致代偿者具有动态稳定性而使非代偿者出现功能障碍的因素,目前知之甚少。本系统文献综述旨在研究相关试验所提供的证据,以确定能够区分ACLD代偿者和非代偿者的测量工具。文献检索发现了9项试验;其中4项符合本综述的纳入标准。这些研究达成的共识是,松弛度测量和IKDC评分无法区分ACLD患者的功能状态。相反,Lysholm评分、KOS-运动评分、KOS-日常生活活动评分和全球膝关节功能评分被认为能够区分ACLD代偿者和非代偿者。对于股四头肌指数和单腿跳在根据功能水平对ACLD患者进行分类方面的有效性存在分歧。得出的结论是,没有单一的测量工具足以确定ACLD个体的功能状态。因此,建议联合使用多种测试,特别是纳入KOS-运动评分、全球膝关节功能评分、跳跃测试和股四头肌指数。