School of Public Health, Sydney Medical School, The University of Sydney, C39-Level 10 North, King George V Building, Royal Prince Alfred Hospital, Missenden Road, PO Box M179, Sydney, NSW, 2050, Australia.
Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
Sports Med. 2019 Mar;49(3):357-363. doi: 10.1007/s40279-018-0995-0.
Following an anterior cruciate ligament (ACL) injury, patients are often reassured that timely surgery followed by intensive physiotherapy will "fix their knee". Not only does this message create a false perception of uncomplicated return to sport (RTS), it also ignores the large body of evidence demonstrating a high RTS re-injury rate following ACL reconstruction. In this article, we propose an individualised approach to the management of ACL injuries that targets a shift away from early surgery and towards conservative management, with surgery 'as needed' and rehabilitation tailored to the patient's RTS goals. Education on the natural history of ACL injuries will ensure patients are not misguided into thinking surgery and intensive rehabilitation guarantees great outcomes. Further, understanding that conservative management is not inferior to surgery-and not more likely to cause knee osteoarthritis-will help the patient make an informed decision. For patients who opt for surgical management, rehabilitation must target strength and functional performance, avoid rapid increases in training load, and be guided by an RTS timeframe that is no shorter than 9 months. The content of rehabilitation should be similar for patients who opt for non-operative management, although the RTS timeframe will likely be shorter. All patients should receive education on the relationship between injury risk and training load, and understand that a home-exercise program is not inferior to intensive physiotherapist-led exercise.
在前交叉韧带 (ACL) 损伤后，患者通常会被告知，及时手术加上强化物理治疗将“修复他们的膝盖”。这种信息不仅造成了对简单重返运动 (RTS) 的错误认知，还忽略了大量证据表明 ACL 重建后 RTS 再受伤率很高。在本文中，我们提出了一种针对 ACL 损伤管理的个体化方法，目标是从早期手术转向保守治疗，根据需要进行手术，并根据患者的 RTS 目标调整康复方案。对 ACL 损伤自然史的教育将确保患者不会误认为手术和强化康复可确保良好的结果。此外，了解保守治疗并不逊于手术，且不太可能导致膝骨关节炎，将有助于患者做出明智的决定。对于选择手术治疗的患者，康复必须针对力量和功能表现，避免训练负荷的快速增加，并以不短于 9 个月的 RTS 时间框架为指导。对于选择非手术治疗的患者，康复内容应相似，尽管 RTS 时间框架可能更短。所有患者都应接受有关受伤风险与训练负荷之间关系的教育，并了解家庭锻炼计划并不逊于强化物理治疗师指导的锻炼。
