Failla Mathew J, Logerstedt David S, Grindem Hege, Axe Michael J, Risberg May Arna, Engebretsen Lars, Huston Laura J, Spindler Kurt P, Snyder-Mackler Lynn
Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania, USA.
Am J Sports Med. 2016 Oct;44(10):2608-2614. doi: 10.1177/0363546516652594. Epub 2016 Jul 14.
Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR.
Cohort study; Level of evidence, 3.
This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromuscular training, to data from the Multicenter Orthopaedic Outcomes Network (MOON) cohort, which did not undergo extended preoperative rehabilitation. Inclusion and exclusion criteria from the DOC were applied to the MOON database to extract a homogeneous sample for comparison. Patients achieved knee impairment resolution before ACLR, and postoperative rehabilitation followed each cohort's respective criterion-based protocol. Patients completed the International Knee Documentation Committee (IKDC) subjective knee form and Knee injury and Osteoarthritis Outcome Score (KOOS) at enrollment and again 2 years after ACLR. RTS rates were calculated for each cohort at 2 years.
After adjusting for baseline IKDC and KOOS scores, the DOC patients showed significant and clinically meaningful differences in IKDC and KOOS scores 2 years after ACLR. There was a significantly higher (P < .001) percentage of DOC patients returning to preinjury sports (72%) compared with those in the MOON cohort (63%).
The cohort treated with additional preoperative rehabilitation consisting of progressive strengthening and neuromuscular training, followed by a criterion-based postoperative rehabilitation program, had greater functional outcomes and RTS rates 2 years after ACLR. Preoperative rehabilitation should be considered as an addition to the standard of care to maximize functional outcomes after ACLR.
前交叉韧带（ACL）重建（ACLR）术前康复至少在短期内对改善术后效果有效。关于术前康复对重建后2年功能结局和恢复运动（RTS）率的影响，人们了解较少。
目的/假设：本研究的目的是比较一组接受额外术前康复（包括在损伤解决后进行渐进性强化和神经肌肉训练）的患者与非实验性队列在ACLR后2年的功能结局。我们假设接受延长术前康复治疗的队列在ACLR后2年将具有更好的功能结局。
队列研究；证据等级，3级。
本研究将接受包括神经肌肉训练在内的延长术前康复治疗的国际队列（特拉华-奥斯陆ACL队列[DOC]）中ACL断裂后的结局与多中心骨科结局网络（MOON）队列的数据进行比较，MOON队列未接受延长术前康复治疗。将DOC的纳入和排除标准应用于MOON数据库，以提取同质样本进行比较。患者在ACLR前实现膝关节损伤解决，术后康复遵循每个队列各自基于标准的方案。患者在入组时以及ACLR后2年再次完成国际膝关节文献委员会（IKDC）主观膝关节表格和膝关节损伤与骨关节炎结局评分（KOOS）。计算每个队列在2年时的RTS率。
在对基线IKDC和KOOS评分进行调整后，DOC患者在ACLR后2年的IKDC和KOOS评分显示出显著且具有临床意义的差异。与MOON队列（63%）相比，DOC患者恢复到伤前运动水平的比例显著更高（P <.001）（72%）。
接受由渐进性强化和神经肌肉训练组成的额外术前康复治疗，随后进行基于标准的术后康复计划的队列，在ACLR后2年具有更好的功能结局和RTS率。术前康复应被视为标准治疗的补充，以最大化ACLR后的功能结局。
