Garrison J Craig, Bothwell Jim, Cohen Kiley, Conway John
Texas Health Ben Hogan Sports Medicine, Fort Worth, TX, USA.
Texas Health Physicians Group, Fort Worth, TX, USA.
Int J Sports Phys Ther. 2014 Apr;9(2):157-67.
PURPOSE/BACKGROUND: It is not clear whether the addition of hip strengthening exercises will improve outcomes during the early stages of ACL rehabilitation. The purpose of this study was to determine the effects of the addition of isolated hip strengthening exercises to traditional rehabilitation on early outcomes (within the first 3 months) after ACL reconstruction (ACLR). METHODS: A total of 43 subjects (18.8±6.9, 21 females, 22 males) who were in the process of rehabilitation following ACLR participated. Subjects were randomly assigned to one of two different treatment groups (1= traditional rehabilitation [NoHip], 2= traditional plus isolated hip strengthening rehabilitation [Hip]). Assessment included the International Knee Documentation Committee (IKDC) Subjective Knee Form, Visual Analog Scale (VAS) for pain during activities of daily living, and knee extension range of motion (ROM) side to side difference taken at weeks 1, 4, 8, and 12. In addition, dynamic balance was assessed with the Y Balance Test™ at 8 and 12 weeks. A mixed model repeated measures ANOVA was performed for IKDC, VAS, and ROM. A one-way ANOVA was used to assess mean group differences for Y Balance Test - Lower Quarter (YBT-LQ) side to side difference scores at 8 and 12 weeks. RESULTS: There was no significant interaction for group by time across VAS (p = .463), IKDC (p = .819), or ROM (p = .513) side to side differences A significant difference was found between groups for YBT-LQ Anterior Reach (ANT) side to side difference at 12 weeks (p = .008) with the Hip group demonstrating smaller side to side reach differences than the NoHip group. No significant side to side differences were seen between groups for YBT-LQ Posteromedial (PM) or Posterolateral (PL) at 12 weeks (PM: p = .254; PL: p = .617). CONCLUSIONS: Rehabilitation including hip strengthening exercises appears to improve sagittal plane dynamic balance at three months post ACLR as compared to traditional rehabilitation. No differences were seen between groups for pain, ROM, and subjective function during the first 3 months following ACLR. LEVEL OF EVIDENCE: Level 2b.
目的/背景：目前尚不清楚在ACL康复早期增加髋关节强化训练是否会改善康复效果。本研究的目的是确定在ACL重建（ACLR）后的早期（前3个月内），在传统康复基础上增加孤立的髋关节强化训练的效果。 方法：共有43名正在进行ACLR康复的受试者（年龄18.8±6.9岁，女性21名，男性22名）参与。受试者被随机分配到两个不同的治疗组之一（1=传统康复组[无髋关节训练组]，2=传统康复加孤立髋关节强化训练组[髋关节训练组]）。评估内容包括国际膝关节文献委员会（IKDC）主观膝关节量表、日常生活活动中疼痛的视觉模拟量表（VAS），以及在第1、4、8和12周测量的膝关节伸展活动范围（ROM）的左右差异。此外，在第8周和第12周用Y平衡测试™评估动态平衡。对IKDC、VAS和ROM进行混合模型重复测量方差分析。采用单因素方差分析评估第8周和第12周Y平衡测试 - 下半身（YBT-LQ）左右差异得分的组间平均差异。 结果：VAS（p = 0.463）、IKDC（p = 0.819）或ROM（p = 0.513）左右差异在组间与时间上均无显著交互作用。在第12周时，YBT-LQ前伸（ANT）左右差异在两组间存在显著差异（p = 0.008），髋关节训练组的左右伸展差异小于无髋关节训练组。在第12周时，两组间YBT-LQ后内侧（PM）或后外侧（PL）左右差异无显著差异（PM：p = 0.254；PL：p = 0.617）。 结论：与传统康复相比，包括髋关节强化训练的康复方案在ACLR后三个月似乎能改善矢状面动态平衡。在ACLR后的前3个月，两组在疼痛、ROM和主观功能方面未见差异。 证据水平：2b级。
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