Private Practice, Nambour, Australia.
School of Health and Sports Sciences, The University of the Sunshine Coast, Sippy Downs, QLD, Australia.
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2511-2519. doi: 10.1007/s00167-018-5258-y. Epub 2018 Nov 1.
Traditionally reconstructive surgery is recommended for patients planning to return to sport (RTS), especially to pivoting sports after anterior cruciate (ACL) rupture. Recent trends focus on delaying or avoiding surgery as some studies have found similar rates of RTS following both surgical and conservative management. This study aimed to establish long-term RTS levels in ACL-ruptured individuals treated conservatively, and to investigate the relationship between outcome measures and RTS, in particular, pivoting sports.
Fifty-five patients from a cohort of 132 ACL-deficient patients were followed-up for 12 (IQR 8,19) years post injury. Mean-aged 42 years, 22 patients were females and 33 males, 35 had meniscal injuries. Patients were treated with physiotherapy focussing on strength and dynamic stability training and not reconstructive surgery. Return to sport was measured on a 6-point scale. Outcome measures included: objective stability, subjective stability, quadriceps and hamstring strength. Spearman's rho and Chi-square tests were used to assess the relationship between RTS and outcome measures.
Eighty-nine percent of ACL-deficient patients were currently participating in sport despite a 38% increase in anterior translation (p < 0.001) and a 7.5% loss of quadriceps strength (p = 0.004) compared to the contralateral side. Six patients (11%) did not RTS, ten (18%) returned to safe sports, five (9%) returned to running and 16 (29%) to non-strenuous sports involving limited twisting. Eighteen patients (33%) returned to pivoting sports, 12(22%) at recreational level and six (11%) at competitive level. The level of RTS was related to subjective stability (p = 0.002), and to quadriceps and hamstring strength of the injured leg (p < 0.001). Patients able to return to pivoting sports differed significantly from those not doing so in outcome measures including objective (p = 0.022) and subjective stability (p = 0.035), and quadriceps strength (p = 0.044).
Eighty-nine percent of ACL-ruptured individuals treated conservatively lead an active sporting life. One-third returned to pivoting sports. Overall RTS was related to subjective and objective stability and quadriceps and to a lesser extent hamstring strength. This finding reinforced the importance of dynamic stability training as an initial treatment option in most cases.
III.
传统上，建议计划重返运动（RTS）的患者进行重建手术，尤其是在前交叉韧带（ACL）断裂后进行旋转运动。最近的趋势侧重于延迟或避免手术，因为一些研究发现，手术和保守治疗后 RTS 的发生率相似。本研究旨在确定保守治疗的 ACL 断裂患者的长期 RTS 水平，并探讨结局测量指标与 RTS 之间的关系，尤其是与旋转运动的关系。
对 132 例 ACL 缺陷患者队列中的 55 例患者进行了 12（IQR8，19）年的随访。平均年龄为 42 岁，22 例为女性，33 例为男性，35 例有半月板损伤。患者接受了以力量和动态稳定性训练为重点的物理治疗，而未进行重建手术。运动回归以 6 分制进行测量。结局测量指标包括：客观稳定性、主观稳定性、股四头肌和腘绳肌力量。使用 Spearman 秩相关系数和卡方检验评估 RTS 与结局测量指标之间的关系。
尽管与对侧相比，前向平移增加了 38%（p<0.001），股四头肌力量下降了 7.5%（p=0.004），但 89%的 ACL 缺陷患者仍在参加体育运动。与未 RTS 的 6 名患者（11%）相比，10 名（18%）患者回归安全运动，5 名（9%）患者回归跑步，16 名（29%）患者回归非剧烈运动，运动时限制扭转。18 名患者（33%）回归旋转运动，12 名（22%）回归休闲运动，6 名（11%）回归竞技运动。RTS 的水平与主观稳定性相关（p=0.002），与受伤腿的股四头肌和腘绳肌力量相关（p<0.001）。能够回归旋转运动的患者与不能回归旋转运动的患者在客观（p=0.022）和主观稳定性（p=0.035）以及股四头肌力量方面存在显著差异（p=0.044）。
89%的 ACL 断裂患者经保守治疗后过着积极的运动生活。三分之一的患者回归旋转运动。总体 RTS 与主观和客观稳定性以及股四头肌有关，与腘绳肌关系较小。这一发现强调了动态稳定性训练作为大多数情况下初始治疗选择的重要性。
III。
