Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):2966-2977. doi: 10.1007/s00167-018-4845-2. Epub 2018 Feb 5.
PURPOSE: A better understanding of patient characteristics and the way common concomitant injuries affect the recovery of muscle function after surgery should help providers to treat patients with anterior cruciate ligament (ACL) injuries. The aim of this study was to determine whether patient characteristics, concomitant injuries and graft choice at ACL reconstruction were associated with symmetrical knee muscle function at one year. The hypothesis was that the presence of concomitant injuries would negatively influence the opportunity to achieve symmetrical knee function at the one-year follow-up. METHODS: Data was extracted from the Swedish National Knee Ligament Register and a rehabilitation outcome register between August 2012 and December 2016. The patients had been evaluated with a battery of tests comprising knee extension and flexion strength, vertical jump, hop for distance and the side-hop test one year after ACL reconstruction. Univariable and multivariable logistic regression analyses were performed with achieving a limb symmetry index (LSI) of ≥ 90% in all tests of muscle function as primary outcome. RESULTS: A total of 263 patients with a mean age of 26.7 ± 10.3 years were included in the study (47% females). No patient demographic or intra-operative predictors were found to be significant when attempting to predict the achievement of a symmetrical muscle function. Lateral meniscus injury and a patellar tendon autograft reduced the odds of achieving an LSI of ≥ 90% in knee extension strength, OR = 0.49 [(95% CI 0.25-0.97), p = 0.039] and OR = 0.30 [(95% CI 0.14-0.67), p = 0.0033] respectively. In addition, reduced odds of recovering knee extension strength were found in older patients, OR = 0.76 [(95% CI 0.60-0.98), p = 0.034]. A higher pre-injury level of physical activity increased the odds of recovering knee flexion strength, OR = 1.14 [(95% CI 1.01-1.29), p = 0.037]. CONCLUSION: Intra-operatively identified concomitant injuries or graft choice did not affect the likelihood of recovering symmetrical performance in five different tests of muscle function one year after ACL reconstruction. However, fewer than one in four patients achieved an LSI of ≥ 90% in all tests. LEVEL OF EVIDENCE: Prospective observational study: Level 2.
目的：更好地了解患者特征以及常见伴随损伤对术后肌肉功能恢复的影响，有助于临床医生治疗前交叉韧带（ACL）损伤患者。本研究旨在确定 ACL 重建时的患者特征、伴随损伤和移植物选择是否与术后一年的膝关节肌肉功能对称性相关。假设是伴随损伤的存在会对术后一年膝关节功能的恢复产生负面影响。
方法：数据取自 2012 年 8 月至 2016 年 12 月期间的瑞典膝关节韧带注册中心和康复结果注册中心。患者在 ACL 重建术后一年接受了一系列测试，包括膝关节伸屈肌力、垂直跳跃、跳远和侧跳测试。采用单变量和多变量逻辑回归分析，以所有肌肉功能测试的肢体对称性指数（LSI）≥90%作为主要结局。
结果：共纳入 263 名平均年龄 26.7±10.3 岁的患者（47%为女性）。在试图预测肌肉功能对称性恢复的过程中，未发现任何患者人口统计学或术中预测因素具有显著意义。外侧半月板损伤和髌腱自体移植物减少了膝关节伸肌力量达到 LSI≥90%的可能性，OR=0.49（95%CI 0.25-0.97），p=0.039；OR=0.30（95%CI 0.14-0.67），p=0.0033。此外，年龄较大的患者膝关节伸肌力量恢复的可能性较低，OR=0.76（95%CI 0.60-0.98），p=0.034。术前更高的身体活动水平增加了膝关节屈肌力量恢复的可能性，OR=1.14（95%CI 1.01-1.29），p=0.037。
结论：术中发现的伴随损伤或移植物选择并不影响 ACL 重建后一年 5 项不同肌肉功能测试中恢复对称性表现的可能性。然而，不到四分之一的患者在所有测试中 LSI 均≥90%。
证据等级：前瞻性观察研究：2 级。
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