Boyle Matthew J, Butler Robert J, Queen Robin M
Michael W. Krzyzewski Human Performance Lab, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
J Pediatr Orthop. 2016 Jan;36(1):36-41. doi: 10.1097/BPO.0000000000000402.
Adolescent patients undergoing anterior cruciate ligament (ACL) reconstruction may not adequately recover safe movement patterns before returning to sport participation. The aims of this study were to assess functional movement and dynamic balance 9 months after primary ACL reconstruction in adolescent patients, and to assess for any maturity-specific differences that may guide rehabilitation strategies.
A series of 39 adolescent patients who underwent primary, anatomic, transphyseal ACL reconstruction using hamstrings autograft from October 2009 to January 2013 were identified from a research database: 17 skeletally immature (SI) patients (mean age 13.6±1.6 y) and 22 skeletally mature (SM) patients (mean age 16.6±1.2 y). An adult reference population of 16 primary ACL reconstruction patients (mean age 27.4±4.0 y) was also identified. All patients followed a standardized operative and rehabilitation protocol. The 3 patient groups were compared 9 months postoperatively using the Functional Movement Screen (FMS) to assess movement competency and the Lower Quarter Y-Balance Test (LQYBT) to assess single-limb dynamic balance.
Nine months postoperatively, the FMS scores for all 3 groups indicated an increased risk for lower extremity injury (total score ≤14). With respect to specific movement patterns, the SI group displayed inferior active straight leg raise score (P=0.006) despite a lower incidence of pain with this movement. With the LQYBT, there was no significant difference in mean anterior (P=0.987), posterolateral (P=0.349), or posteromedial (P=0.870) reach asymmetry between the 3 groups; however, the adolescent groups demonstrated wider ranges of anterior reach asymmetry than the adult group indicating an increased risk for injury.
Adolescent patients undergoing primary ACL reconstruction do not consistently recover adequate functional movement patterns by 9 months postoperatively to permit a safe return to sport. We have identified unique functional movement deficits in SI and SM adolescents, which highlight the need for maturity-specific rehabilitation strategies for adolescent patients undergoing ACL reconstruction.
Level IV—retrospective cohort
接受前交叉韧带（ACL）重建的青少年患者在恢复运动参与之前可能无法充分恢复安全的运动模式。本研究的目的是评估青少年患者初次ACL重建9个月后的功能运动和动态平衡，并评估可能指导康复策略的任何成熟度特异性差异。
从一个研究数据库中确定了2009年10月至2013年1月期间接受使用腘绳肌自体移植物进行初次、解剖学、经骨骺ACL重建的39例青少年患者：17例骨骼未成熟（SI）患者（平均年龄13.6±1.6岁）和22例骨骼成熟（SM）患者（平均年龄16.6±1.2岁）。还确定了16例初次ACL重建患者的成人参考人群（平均年龄27.4±4.0岁）。所有患者均遵循标准化的手术和康复方案。术后9个月，使用功能运动筛查（FMS）评估运动能力，使用下肢Y平衡测试（LQYBT）评估单腿动态平衡，对3组患者进行比较。
术后9个月，所有3组的FMS评分均表明下肢受伤风险增加（总分≤14）。就特定运动模式而言，SI组的主动直腿抬高评分较低（P=0.006），尽管该运动时疼痛发生率较低。使用LQYBT时，3组之间在前（P=0.987）、后外侧（P=0.349）或后内侧（P=0.870）伸展不对称的平均值上没有显著差异；然而，青少年组的前伸展不对称范围比成人组更宽，表明受伤风险增加。
接受初次ACL重建的青少年患者在术后9个月时并未始终如一地恢复足够的功能运动模式以允许安全恢复运动。我们已经确定了SI和SM青少年独特的功能运动缺陷，这突出了对接受ACL重建的青少年患者采用成熟度特异性康复策略的必要性。
IV级——回顾性队列研究
