Isberg Jonas, Faxén Eva, Brandsson Sveinbjörn, Eriksson Bengt I, Kärrholm Johan, Karlsson Jon
Department of Orthopaedics, Sahlgrenska University Hospital, 416 85 Goteborg, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2006 Nov;14(11):1108-15. doi: 10.1007/s00167-006-0138-2. Epub 2006 Sep 6.
If permission of full active and passive extension immediately after an anterior cruciate ligament (ACL) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion. We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior-posterior knee laxity (A-P laxity). Our hypothesis was that full active and passive extension immediately after an ACL reconstruction would have no effect on the A-P laxity and clinical results up to 2 years after the operation. Twenty-two consecutive patients (14 men, 8 women, median age 21 years, range 17-41) were included. All the patients had a unilateral ACL rupture and no other ligament injuries or any other history of previous knee injuries. The surgical procedure was identical in all patients and one experienced surgeon operated on all the patients, using the bone-patellar tendon-bone autograft. The post-operative rehabilitation programme was identical in both groups, except for extension training during the first 4 weeks post-operatively. The patients were randomly allocated to post-operative rehabilitation programmes either allowing (Group A, n=11) or not allowing [Group B (30 to -10 degrees ), n=11] full active and passive extension immediately after the operation. They were evaluated pre-operatively and at 6 months and 2 years after the reconstruction. To evaluate the A-P knee laxity, radiostereometric analysis (RSA) and KT-1000 arthrometer (KT-1000) measurements were used, range of motion, Lysholm score, Tegner activity level, the International Knee Documentation Committee (IKDC) evaluation system and one-leg-hop test quotient were used. Pre-operatively, the RSA measurements revealed side-to-side differences in Group A of 8.6 mm (2.3-15.4), median (range) and in Group B of 7.2 mm (2.2-17.4) (n.s.). The corresponding KT-1000 values were for Group A, 2.0 mm (0-8.0) and Group B, 4.0 mm (0-10.0) (n.s.). At 2 years, the differences between the two groups were minimal, regardless of the method that had been used. The RSA measurements in Group A were 2.7 mm (0-10.7) and in Group B 2.8 (-1.8 to 9.5). The KT-1000 values were for Group A, 1.0 mm (-1.5 to 3.5), and for Group B, 0.5 mm (-1.0 to 4.0), without any significant differences between the groups. Nor did the Lysholm score, Tegner activity level, IKDC or one-leg-hop test differ. Early active and passive extension training, without any restrictions in extension, immediately after an ACL reconstruction using bone-patellar tendon-bone graft did not increase post-operative knee laxity up to 2 years after the ACL reconstruction.
前交叉韧带（ACL）重建术后立即进行完全主动和被动伸展是否会增加膝关节术后松弛度一直是一个讨论的话题。我们研究了一种术后康复方案，即在ACL重建术后立即进行主动和被动伸展且不限制伸展，是否会增加术后膝关节前后向松弛度（A-P松弛度）。我们的假设是，ACL重建术后立即进行完全主动和被动伸展对术后2年内的A-P松弛度和临床结果没有影响。纳入了22例连续患者（14例男性，8例女性，中位年龄21岁，范围17 - 41岁）。所有患者均为单侧ACL断裂，无其他韧带损伤或既往膝关节损伤史。所有患者的手术操作相同，由一位经验丰富的外科医生对所有患者进行手术，采用骨-髌腱-骨自体移植物。两组的术后康复方案相同，除了术后前4周的伸展训练。患者被随机分配到术后康复方案中，一组（A组，n = 11）术后立即允许完全主动和被动伸展，另一组（B组，伸展范围为30°至 - 10°，n = 11）术后不允许。在术前以及重建后6个月和2年对他们进行评估。为了评估膝关节A-P松弛度，使用了放射立体测量分析（RSA）和KT - 1000关节测量仪（KT - 1000）测量，还使用了活动范围、Lysholm评分、Tegner活动水平、国际膝关节文献委员会（IKDC）评估系统和单腿跳测试商数。术前，RSA测量显示A组的左右侧差异为8.6 mm（中位数（范围），2.3 - 15.4），B组为7.2 mm（2.2 - 17.4）（无统计学差异）。相应的KT - 1000值，A组为2.0 mm（0 - 8.0），B组为4.0 mm（0 - 10.0）（无统计学差异）。在2年时，无论使用何种方法，两组之间的差异都很小。A组的RSA测量值为2.7 mm（0 - 10.7），B组为2.8 mm（-1.8至9.5）。KT - 1000值，A组为1.0 mm（-1.5至3.5），B组为0.5 mm（-1.0至4.0），两组之间无显著差异。Lysholm评分、Tegner活动水平、IKDC或单腿跳测试也没有差异。在使用骨-髌腱-骨移植物进行ACL重建术后立即进行早期主动和被动伸展训练且不限制伸展，在ACL重建术后2年内不会增加术后膝关节松弛度。
