Faculty of Medicine, Health and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Arthroscopy. 2013 Nov;29(11):1879-95. doi: 10.1016/j.arthro.2013.07.273.
The aim of this systematic review was to determine which patient determinants and injury factors, before anterior cruciate ligament reconstruction by arthroscopic single-bundle techniques, affect postoperative rehabilitation.
A search of PubMed, Embase, and the Cochrane Database of Clinical Trials was performed up to February 2013. After application of our inclusion criteria, a final selection was made based on studies' methodologic score assessed with the Newcastle-Ottawa Scale. Meta-analysis was planned for each prognostic factor when data were considered clinically and statistically homogeneous.
Meta-analysis showed that male patients have better functional outcomes. Qualitative synthesis from 18 high-quality studies showed that patients operated on before 30 years of age reach higher activity levels. Patients with high baseline body mass index have lower activity levels after surgery. Smoking results in more symptoms and lower activity levels and subjective scores. Reconstruction before 3 months results in higher activity levels. Preoperatively, a less than 20% quadriceps strength difference, 50° of tibial external rotation or less, absence of flexion deficits, low knee influence on the patient's activity level, and less anterior knee pain result in higher functional scores. Preoperative anterior laxity difference does not predict functional scores. The prognostic value of preoperative activity and competition level for postoperative functional outcome is controversial. Patients with concomitant meniscal injuries have worse functional outcomes. The prognostic value of concomitant chondral pathology for postoperative functional outcome is controversial. Collateral ligament injury could predict functional scores or activity level.
Male gender, patient age younger than 30 years, reconstruction before 3 months, and high baseline activity level contribute to better functional outcomes. Smoking, high body mass index, quadriceps strength, and range-of-motion deficits affect rehabilitation negatively. Preoperative anterior laxity does not influence rehabilitation. The role of preoperative prognostic injury factors remains unclear because of limited evidence.
Level III, systematic review of Level II and III studies.
本系统回顾的目的是确定在关节镜下单束技术进行前交叉韧带重建之前，哪些患者决定因素和损伤因素会影响术后康复。
我们对 PubMed、Embase 和 Cochrane 临床试验数据库进行了搜索，检索截至 2013 年 2 月。在应用我们的纳入标准后，根据纽卡斯尔-渥太华量表评估的研究方法学评分，最终进行了选择。当数据被认为具有临床和统计学同质性时，计划对每个预后因素进行荟萃分析。
荟萃分析显示，男性患者的功能结果更好。18 项高质量研究的定性综合表明，30 岁以下接受手术的患者达到更高的活动水平。基线体重指数较高的患者术后活动水平较低。吸烟导致更多症状和较低的活动水平和主观评分。3 个月内重建导致更高的活动水平。术前，股四头肌力量差异小于 20%、胫骨外旋小于 50°、无屈伸缺陷、膝关节对患者活动水平的影响较低以及前膝疼痛较少，结果是功能评分较高。术前松弛度差异不能预测功能评分。术前活动水平和比赛水平对术后功能结果的预后价值存在争议。合并半月板损伤的患者功能结果较差。伴随软骨病理对术后功能结果的预后价值存在争议。侧副韧带损伤可能预测功能评分或活动水平。
男性、30 岁以下的患者年龄、3 个月内重建以及高基线活动水平有助于获得更好的功能结果。吸烟、高体重指数、股四头肌力量和运动范围缺陷会对康复产生负面影响。术前松弛度不影响康复。由于证据有限，术前预后损伤因素的作用仍不清楚。
III 级，对 II 级和 III 级研究的系统评价。
