Schmitt Laura C, Quatman Carmen E, Paterno Mark V, Best Thomas M, Flanigan David C
Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH.
J Orthop Sports Phys Ther. 2014 Aug;44(8):565-A10. doi: 10.2519/jospt.2014.4844. Epub 2014 Jun 23.
Systematic literature review.
To systematically review the literature relative to muscle performance, knee joint biomechanics, and performance-based functional outcomes following articular cartilage repair and restoration surgical procedures in the knee.
Articular cartilage injuries are associated with functional limitations, poor quality of life, and the potential for long-term disability. This review systematically evaluates evidence related to muscle performance, joint biomechanics, and performance-based functional outcomes following articular cartilage procedures, and discusses their implications for rehabilitation.
The online databases of PubMed (MEDLINE), CINAHL, SPORTDiscus, and Scopus were searched (inception to September 2013). Studies pertaining to muscle performance, knee joint biomechanics, and performance-based measures of function following articular cartilage procedure in the knee were included.
Sixteen articles met the specified inclusion criteria. Seven studies evaluated muscle performance, all showing persistent deficits in quadriceps femoris muscle strength for up to 7 years postprocedure. Quadriceps femoris strength deficits of greater than 20% were noted in 33% and 26% of individuals at 1 and 2 years following microfracture and autologous chondrocyte implantation (ACI), respectively. Two studies evaluated knee mechanics post-ACI, showing persistent deficits in knee kinematics and kinetics for up to 12 months postprocedure compared to uninjured individuals. Seven studies showed improved functional capacity (6-minute walk test) over time, and 3 studies showed persistent performance deficits during higher-level activities (single-leg hop test) for up to 6 years postprocedure. Five studies comparing weight-bearing protocols (accelerated versus traditional/current practice) following ACI found few differences between the groups in function and gait mechanics; however, persistent gait alterations were observed in both groups compared to uninjured individuals.
Significant quadriceps femoris strength deficits, gait deviations, and functional deficits persist for 5 to 7 years following ACI and microfracture surgical procedures. Future research regarding rehabilitation interventions to help mitigate these deficits is warranted. Level of Evidence Prognosis, level 2a-.
系统文献综述。
系统回顾有关膝关节软骨修复与重建手术后肌肉功能、膝关节生物力学以及基于功能表现的功能结局的文献。
关节软骨损伤与功能受限、生活质量差以及长期残疾的可能性相关。本综述系统评估了关节软骨手术后与肌肉功能、关节生物力学以及基于功能表现的功能结局相关的证据，并讨论了它们对康复的影响。
检索了PubMed（MEDLINE）、CINAHL、SPORTDiscus和Scopus的在线数据库（起始至2013年9月）。纳入了有关膝关节软骨手术后肌肉功能、膝关节生物力学以及基于功能表现的功能测量的研究。
16篇文章符合指定的纳入标准。7项研究评估了肌肉功能，均显示术后长达7年股四头肌力量持续存在缺陷。微骨折和自体软骨细胞植入（ACI）术后1年和2年，分别有33%和26%的个体股四头肌力量缺陷大于20%。2项研究评估了ACI术后的膝关节力学，显示与未受伤个体相比，术后长达12个月膝关节运动学和动力学持续存在缺陷。7项研究显示随着时间推移功能能力（6分钟步行试验）有所改善，3项研究显示术后长达6年在更高水平活动（单腿跳试验）中持续存在功能缺陷。5项比较ACI术后负重方案（加速与传统/当前做法）的研究发现，两组在功能和步态力学方面差异不大；然而，与未受伤个体相比，两组均观察到持续的步态改变。
ACI和微骨折手术后，股四头肌力量显著缺陷、步态偏差和功能缺陷会持续5至7年。有必要开展关于康复干预以帮助减轻这些缺陷的未来研究。证据水平：预后，2a级。
