Wang Lin, Xiong Kaiyu, Wang Bo, Liang Xiaotian, Li Haiwei, Liu Haitao, He Hui
Section of Sports Medicine, Beijing Sport University, Beijing, China.
Teaching Laboratory, Beijing Sport University, Beijing, China.
Am J Sports Med. 2017 Aug;45(10):2405-2410. doi: 10.1177/0363546517712223. Epub 2017 Jun 21.
A patellar tendon injury is a common injury in sports. The optimal time to start training after an acute, proximal patellar enthesis injury is still unclear.
The time to start training after an acute, proximal patellar enthesis injury significantly affects healing of the patellar tendon 4 weeks after the injury.
Controlled laboratory study.
The left hindlimbs of 35 mature female rabbits were randomly assigned to 5 injury groups including a 4-week natural healing group (NH4W) and 4 training groups that started low-intensity training at 24 hours (POST24), 48 hours (POST48), 72 hours (POST72), and 96 hours (POST96) after an acute patellar tendon injury, with 7 limbs in each group. The right hindlimbs of the NH4W group were used as a control group (CON). An acute, proximal patellar enthesis injury was created in all injury groups. The training groups underwent low-intensity quadriceps training for 2 hours per day and 3 days per week for 4 weeks. Histological and radiographic data were collected and analyzed.
The cell densities of the training groups were significantly lower than those of the NH4W and CON groups ( P = .01). The fibrocartilage zone was significantly thicker in the POST24, POST48, and POST72 groups compared with the CON and NH4W groups and was the thickest in the POST24 group ( P = .01). The bone surface to bone volume ratio was significantly higher in all the injury groups compared with the CON group and in the POST24 group compared with the other groups ( P = .01). Trabecular thickness was significantly lower in all the injury groups compared with the CON group and in the POST24 group compared with the other groups ( P = .01).
Resting without training in the first 96 hours after an acute patellar tendon enthesis injury resulted in the best recovery of cell density in the tendon enthesis 4 weeks after the injury. Starting training 96 hours after the injury resulted in the best recovery of fibrocartilage zone thickness. Starting training 48 to 96 hours after the injury resulted in the best healing of the bone component of the attachment site 4 weeks after the injury. The optimal time to start training may be longer than 96 hours after an acute patellar tendon enthesis injury for the best overall healing of the tendon enthesis 4 weeks after the injury.
A rest of a minimal 72 hours may be needed for the best healing of a patellar tendon enthesis after an acute injury. Future studies are needed to determine the optimal time to start training after an acute patellar tendon injury.
髌腱损伤是运动中常见的损伤。急性近端髌腱附着点损伤后开始训练的最佳时间仍不明确。
急性近端髌腱附着点损伤后开始训练的时间会显著影响损伤后4周髌腱的愈合情况。
对照实验室研究。
将35只成年雌性兔的左后肢随机分为5个损伤组，包括一个4周自然愈合组（NH4W）和4个训练组，后者在急性髌腱损伤后24小时（POST24）、48小时（POST48）、72小时（POST72）和96小时（POST96）开始低强度训练，每组7只兔。NH4W组的右后肢用作对照组（CON）。所有损伤组均造成急性近端髌腱附着点损伤。训练组每天进行2小时、每周3天的低强度股四头肌训练，持续4周。收集并分析组织学和影像学数据。
训练组的细胞密度显著低于NH4W组和CON组（P = 0.01）。与CON组和NH4W组相比，POST24组、POST48组和POST72组的纤维软骨区明显更厚，POST24组最厚（P = 0.01）。与CON组相比，所有损伤组的骨表面积与骨体积比显著更高，与其他组相比，POST24组也更高（P = 0.01）。与CON组相比，所有损伤组的小梁厚度显著更低，与其他组相比，POST24组也更低（P = 0.01）。
急性髌腱附着点损伤后的前96小时不进行训练休息，能使损伤后4周腱附着点的细胞密度恢复最佳。损伤后96小时开始训练能使纤维软骨区厚度恢复最佳。损伤后48至96小时开始训练能使损伤后4周附着部位的骨成分愈合最佳。对于损伤后4周腱附着点的最佳整体愈合，急性髌腱附着点损伤后开始训练的最佳时间可能长于96小时。
急性损伤后，髌腱附着点的最佳愈合可能需要至少72小时的休息。需要进一步研究以确定急性髌腱损伤后开始训练的最佳时间。
