J Orthop Sports Phys Ther. 2018 Jul;48(7):552-566. doi: 10.2519/jospt.2018.7656. Epub 2018 Apr 23.
Background There is controversy surrounding the early use of open-kinetic-chain (OKC) quadriceps-strengthening exercises following anterior cruciate ligament reconstruction (ACLR) due to the belief that increased strain on the graft could cause damage. Objectives To determine whether OKC quadriceps exercises result in differences in anterior tibial laxity, strength, function, quality of life, or adverse events in the ACLR population, when compared to closed-kinetic-chain (CKC) quadriceps exercises. Methods Seven electronic databases (MEDLINE, Embase, AMED, CINAHL, SPORTDiscus, PEDro, and the Cochrane Central Register of Controlled Trials) were searched through April 2017. A systematic review with meta-analysis was conducted on randomized controlled trials comparing OKC versus CKC exercises following ACLR. Outcomes of interest were tibial laxity, strength, and function. A methodological quality assessment of the included studies was completed, and the results were synthesized using meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Ten studies were included in the review. The meta-analysis demonstrated low- to moderate-quality evidence of no between-group differences in anterior tibial laxity, strength, or patient-reported function at any time point. Meta-analysis was unable to be performed for functional outcomes. Conclusion There was limited to moderate-quality evidence of no difference in anterior tibial laxity, strength, patient-reported function, or physical function with early or late introduction of OKC exercises in the ACLR population, when compared to CKC exercises, at all follow-up time points. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(7):552-566. Epub 23 Apr 2018. doi:10.2519/jospt.2018.7656.
由于担心增加移植物的张力会造成损伤，在前交叉韧带重建（ACL）后早期使用开放式运动链（OKC）股四头肌强化锻炼存在争议。目的：与闭链运动链（CKC）股四头肌锻炼相比，确定 OKC 股四头肌锻炼是否会在前交叉韧带重建人群中导致前胫骨松弛度、力量、功能、生活质量或不良事件的差异。方法：通过 2017 年 4 月，检索了 7 个电子数据库（MEDLINE、Embase、AMED、CINAHL、SPORTDiscus、PEDro 和 Cochrane 对照试验中心注册库）。对比较 ACLR 后 OKC 与 CKC 锻炼的随机对照试验进行了系统评价和荟萃分析。感兴趣的结局是胫骨松弛度、力量和功能。对纳入研究进行了方法学质量评估，并使用荟萃分析和推荐评估、制定与评价（GRADE）方法对结果进行综合。结果：共纳入 10 项研究。荟萃分析结果表明，在任何时间点，两组间在前胫骨松弛度、力量或患者报告的功能方面均无差异，证据质量为低到中。无法对功能结局进行荟萃分析。结论：与 CKC 锻炼相比，在 ACLR 人群中，早期或晚期引入 OKC 锻炼与 CKC 锻炼相比，在前胫骨松弛度、力量、患者报告的功能或身体功能方面，在所有随访时间点均无差异，证据质量为有限到中等。临床意义：在 ACLR 人群中，早期或晚期引入 OKC 锻炼与 CKC 锻炼相比，在所有随访时间点，在前胫骨松弛度、力量、患者报告的功能或身体功能方面，差异无临床意义。
