Mauro Craig S, Irrgang James J, Williams Brian A, Harner Christopher D
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Arthroscopy. 2008 Feb;24(2):146-53. doi: 10.1016/j.arthro.2007.08.026. Epub 2007 Nov 5.
The purpose of this study was to determine the incidence of and factors associated with loss of extension (LOE) 4 weeks after anterior cruciate ligament (ACL) reconstruction using the new IKDC Knee Ligament Evaluation Form criteria for loss of motion.
A retrospective review of patients who had undergone arthroscopic ACL reconstruction between 1995 and 2000 was performed. An endoscopic single tunnel technique with autograft or allograft was used in all cases. A standardized physical therapy program was prescribed to all patients. Subjects with revision ACL reconstruction, concomitant ligament surgery, meniscal transplantation, or any articular cartilage surgery were excluded. LOE was defined as greater than a 5 degrees side-to-side difference in passive knee extension 4 weeks after surgery, the need for repeat arthroscopy to restore extension, or use of a drop-out cast to restore extension.
Fifty-eight of 229 (25.3%) patients developed LOE 4 weeks after ACL reconstruction. LOE was not associated with age, sex, presence of nerve block, concomitant meniscal procedures, specific graft type, or tourniquet time (P > .05). LOE was significantly associated with preoperative extension, time from injury to surgery, and use of autograft (P < .05). Twenty-eight (12.2%) patients underwent an arthroscopic procedure to recover loss of motion. Following arthroscopy, 4 (1.7%) patients had passive motion deficits between 6 degrees and 10 degrees , with none greater than 10 degrees .
Preoperative range of motion and time to surgery are intimately related to a patient's postoperative extension. While 48% of patients that lacked full extension by 4 weeks eventually required arthroscopic debridement to achieve satisfactory extension, our treatment algorithm led to an overall incidence of LOE greater than 5 degrees at final follow-up of 1.7%.
Level III, therapeutic, retrospective, comparative study.
本研究旨在采用新的IKDC膝关节韧带评估表中运动丧失标准，确定前交叉韧带（ACL）重建术后4周伸展丧失（LOE）的发生率及相关因素。
对1995年至2000年间接受关节镜下ACL重建的患者进行回顾性研究。所有病例均采用自体移植物或同种异体移植物的内镜下单隧道技术。为所有患者制定标准化物理治疗方案。排除接受ACL翻修重建、同期韧带手术、半月板移植或任何关节软骨手术的患者。LOE定义为术后4周被动膝关节伸展时双侧差异大于5度、需要再次关节镜检查以恢复伸展或使用支具恢复伸展。
229例患者中有58例（25.3%）在ACL重建术后4周出现LOE。LOE与年龄、性别、是否存在神经阻滞、同期半月板手术、特定移植物类型或止血带使用时间无关（P>.05）。LOE与术前伸展、受伤至手术的时间以及自体移植物的使用显著相关（P<.05）。28例（12.2%）患者接受了关节镜手术以恢复运动丧失。关节镜检查后，4例（1.7%）患者的被动运动 deficit在6度至10度之间，无大于10度者。
术前活动范围和手术时间与患者术后伸展密切相关。虽然4周时未完全伸展的患者中有48%最终需要关节镜清创以获得满意的伸展，但我们的治疗方案导致最终随访时LOE大于5度的总体发生率为1.7%。
III级，治疗性、回顾性、对比研究。
