Dempsey Ian J, Norte Grant E, Hall Matthew, Goetschius John, Slater Lindsay V, Cancienne Jourdan M, Werner Brian C, Diduch David R, Hart Joseph M
J Sport Rehabil. 2019 Feb 1;28(2):171-179. doi: 10.1123/jsr.2017-0176. Epub 2018 Nov 30.
Postoperative rehabilitation is critical to optimize outcomes after anterior cruciate ligament reconstruction (ACLR). However, the relationship between physical therapy (PT) and clinical outcomes is unclear.
To describe PT characteristics following ACLR and to assess the relationships between PT characteristics, surgical procedure, and clinical outcomes.
Cross-sectional.
Laboratory. Patients (or Other Participants): A total of 60 patients (31 females/29 males, age = 22.4 [9.2] y, height = 171.7 [9.9] cm, and mass = 70.2 [14.7] kg) with a history of primary unilateral ACLR (53.6% patellar tendon and 46.4% hamstring) participated.
INTERVENTION(S): Patients completed a performance assessment and rated subjective knee function prior to physician clearance (mean = 6.3 [1.3] mo postoperatively) and were contacted within 6 months of clearance to complete a PT questionnaire.
PT questionnaire item response, knee extension maximum voluntary isometric contraction (MVIC) torque, peak isokinetic knee extension torque, single leg hop distance, and International Knee Documentation Committee were measured. Correlations assessed relationships between PT quantity and clinical outcomes. Independent t tests compared PT quantity and clinical outcomes based on return-to-sport status, readiness to return to sport, and surgical procedure.
Patients completed regular PT (2 d/wk, 25 wk, 58 visits) and were most likely to conclude when discharged by the therapist (68.3%). More than half (56.7%) returned to sport, yet most (73.3%) felt unready at discharge. Isokinetic torque was correlated with days of PT/week (r = .29, P = .03). Isokinetic torque and hop symmetry were reduced in patients who returned to sport (P < .05). Patients who felt ready to return completed fewer weeks of PT (P < .05). Patients with a patellar tendon graft completed more days of PT/week and total visits, but demonstrated lower MVIC torque, MVIC symmetry, and isokinetic symmetry (P < .05).
Many patients felt unready to return to sport at PT discharge. PT frequency was associated with isokinetic torque, yet this relationship was small. Outcomes were reduced in patients who returned to sport, suggesting premature resumption of preinjury activity.
术后康复对于优化前交叉韧带重建（ACLR）后的效果至关重要。然而，物理治疗（PT）与临床效果之间的关系尚不清楚。
描述ACLR后的PT特征，并评估PT特征、手术方式和临床效果之间的关系。
横断面研究。
实验室。患者（或其他参与者）：共有60例患者（31名女性/29名男性，年龄=22.4[9.2]岁，身高=171.7[9.9]厘米，体重=70.2[14.7]千克）有原发性单侧ACLR病史（53.6%为髌腱，46.4%为腘绳肌）参与研究。
患者在医生批准前（术后平均6.3[1.3]个月）完成了一次性能评估并对主观膝关节功能进行了评分，并在批准后的6个月内被联系以完成一份PT问卷。
测量PT问卷项目回答情况、膝关节伸展最大自主等长收缩（MVIC）扭矩、等速膝关节伸展峰值扭矩、单腿跳远距离和国际膝关节文献委员会评分。相关性分析评估PT量与临床效果之间的关系。独立t检验根据恢复运动状态、恢复运动准备情况和手术方式比较PT量与临床效果。
患者接受了规律的PT治疗（每周2天，共25周，58次就诊），最有可能在治疗师批准出院时结束治疗（68.3%）。超过一半（56.7%）的患者恢复了运动，但大多数（73.3%）在出院时感觉尚未准备好。等速扭矩与每周PT天数相关（r=0.29，P=0.03）。恢复运动的患者等速扭矩和跳跃对称性降低（P<0.05）。感觉准备好恢复运动的患者接受PT治疗的周数较少（P<0.05）。髌腱移植患者每周接受PT治疗的天数和总就诊次数更多，但MVIC扭矩、MVIC对称性和等速对称性较低（P<0.05）。
许多患者在PT治疗出院时感觉尚未准备好恢复运动。PT频率与等速扭矩相关，但这种关系较小。恢复运动的患者效果较差，表明过早恢复伤前活动。
