Nyland John, Mattocks Alma, Kibbe Shane, Kalloub Alaa, Greene Joe W, Caborn David N M
Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA; Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA.
Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA.
Open Access J Sports Med. 2016 Feb 24;7:21-32. doi: 10.2147/OAJSM.S72332. eCollection 2016.
Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL) injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends.
解剖学上的发现以及对膝关节作为一个复杂器官的认识不断加深，正在推动前交叉韧带（ACL）损伤后患者护理决策方面的创新。外科医生正加大努力恢复机械 - 神经感觉联合的ACL功能，并更多地考虑何时进行重建而非修复天然解剖结构。手术选择现在包括在有或没有基于缝线的内部支撑来加强受伤的ACL的情况下进行初次修复，并且越来越多的证据支持使用富含血小板血浆和间充质干细胞进行生物增强以促进组织愈合。物理治疗师和运动训练师正加大努力，以便在治疗性运动表现过程中促进运动员更高的认知参与度，从而更好地恢复未受损的神经肌肉控制激活幅度和时机。膝关节支具的设计和使用需要改进，以更好地匹配这些创新及其对康复计划时间表的影响。人们越来越认识到康复过程的多方面特征以及它们如何影响神经肌肉、教育和心理行为治疗目标的实现。在恢复运动过程中，多个因素可能会影响运动员，临床结果测量需要完善以更好地评估这些影响。本更新总结了当代ACL手术、医学和康复干预措施以及未来趋势。
