Karasel Seide, Akpinar Berrin, Gülbahar Selmin, Baydar Meltem, El Ozlem, Pinar Halit, Tatari Hasan, Karaoğlan Osman, Akalin Elif
Department of Physical Medicine and Rehabilitation, Medicine Faculty of Dokuz Eylül University, İzmir, Turkey.
Acta Orthop Traumatol Turc. 2010;44(3):220-8. doi: 10.3944/AOTT.2010.2293.
The aim of this study was to evaluate the clinical and functional outcomes and proprioceptive function in patients who received a modified accelerated rehabilitation program after anterior cruciate ligament (ACL) reconstruction with a patellar tendon (PT) graft.
The study included 38 patients (33 men, 5 women; mean age 27.6 ± 6.4 years; range 18 to 45 years) who underwent ACL reconstruction with a PT graft and participated in a modified accelerated rehabilitation program. Only six patients were athletes. Isokinetic strengths of concentric knee extension and flexion were measured with the Cybex isokinetic dynamometer, and static balance was tested with the Sport-KAT device. For proprioceptive assessment, active repositioning was measured at knee flexions of 40°, 20°, and 5° with an isokinetic dynamometer. Activity levels and subjective functional results were evaluated with the Tegner activity scale and Lysholm knee score, respectively. For objective functional testing, single leg hop, triple leg hop, and one-legged crossover hop tests were used. Knee stability was assessed with the Lachman test and anterior drawer test and knee range of motion was measured. The mean follow-up period was 16.2 ± 9.8 months.
There was no graft failure during the follow-up. Twenty patients (52.6%) had hypoesthesia at the donor site and 15 patients (39.5%) had anterior knee pain. Before surgery, all the patients had positive results in the Lachman and anterior drawer tests. After surgery, the Lachman test was negative in 32 patients (84.2%), while six patients (15.8%) had grade 1 laxity. The mean Lysholm knee score showed a significant increase postoperatively (p<0.001). The mean preoperative and postoperative Tegner activity scores were not significantly different (p>0.05). There were no significant differences in the range of motion between operated and uninjured extremities (p>0.05). The two extremities were similar in proprioception and balance (p>0.05). Isokinetic quadriceps muscle strength was significantly decreased in the operated extremity only in extension at 60°/sec angular velocity (p<0.05). Other muscle strength measurements were similar in both extremities. The ratios of flexion/extension muscle strength were significantly greater in the involved extremity at all angular velocities (p<0.05). The mean performance scores of three functional tests were more than 85% of the uninvolved extremity. All the patients returned to preinjury daily activities or sports activities in 6 to 12 months postoperatively.
We had satisfactory clinical, proprioceptive, and functional results in achieving dynamic and static stability of the knee with the modified accelerated rehabilitation program after ACL reconstruction with a PT graft.
本研究旨在评估接受髌腱（PT）移植重建前交叉韧带（ACL）后采用改良加速康复方案患者的临床和功能结局以及本体感觉功能。
本研究纳入38例患者（33例男性，5例女性；平均年龄27.6±6.4岁；范围18至45岁），这些患者接受了PT移植ACL重建并参与了改良加速康复方案。仅有6例患者为运动员。使用Cybex等速测力计测量膝关节伸肌和屈肌的等速肌力，并用Sport-KAT设备测试静态平衡。对于本体感觉评估，使用等速测力计在膝关节屈曲40°、20°和5°时测量主动复位。分别使用Tegner活动量表和Lysholm膝关节评分评估活动水平和主观功能结果。对于客观功能测试，采用单腿跳、双腿跳和单腿交叉跳测试。通过Lachman试验和前抽屉试验评估膝关节稳定性，并测量膝关节活动范围。平均随访期为16.2±9.8个月。
随访期间未发生移植物失败。20例患者（52.6%）供区感觉减退，15例患者（39.5%）存在膝前疼痛。术前，所有患者Lachman试验和前抽屉试验结果均为阳性。术后，32例患者（84.2%）Lachman试验为阴性，6例患者（15.8%）存在1级松弛。术后Lysholm膝关节评分均值显著增加（p<0.001）。术前和术后Tegner活动评分均值无显著差异（p>0.05）。手术侧和未受伤侧肢体活动范围无显著差异（p>0.05）。两侧肢体在本体感觉和平衡方面相似（p>0.05）。仅在角速度为60°/秒伸展时，手术侧肢体等速股四头肌肌力显著降低（p<0.05）。其他肌力测量在两侧肢体相似。在所有角速度下，患侧肢体屈伸肌力比均显著更高（p<0.05）。三项功能测试的平均表现评分超过未受累侧肢体的85%。所有患者在术后6至12个月恢复到伤前日常活动或体育活动。
采用改良加速康复方案在PT移植重建ACL后实现膝关节动态和静态稳定方面，我们获得了满意的临床、本体感觉和功能结果。
