Shibata Yohei, Matsushita Takehiko, Araki Daisuke, Kida Akihiro, Takiguchi Kohei, Ueda Yuya, Ono Kumiko, Matsumoto Tomoyuki, Niikura Takahiro, Sakai Yoshitada, Kuroda Ryosuke
Devision of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Orthop Sci. 2019 Mar;24(2):301-305. doi: 10.1016/j.jos.2018.10.007. Epub 2018 Nov 2.
The wide variations in patient demographics and concomitant injuries make the prediction of which patients will regain strength quickly following anterior cruciate ligament (ACL) reconstruction challenging. This study aimed to identify the dominant factor affecting quadriceps strength recovery after ACL reconstruction with a hamstring tendon autograft and to construct a predictive model for quadriceps strength recovery using decision tree analysis.
Three hundred and eighty-six patients who underwent ACL reconstruction with a hamstring tendon autograft were included in this study. The isokinetic quadriceps strength at 60°/s was measured preoperatively and at 6 months after surgery. The quadriceps strength index (QSI) was calculated by normalising the peak torque of the involved leg with the uninvolved leg and multiplying it by 100. A stepwise multiple linear regression and a decision tree analysis were performed to assess whether or not the following parameters affect quadriceps strength recovery at 6 months: socio-demographic data and maximum isokinetic quadriceps strength.
The preoperative QSI, age, and pre-injury Tegner activity scale were independently correlated with quadriceps strength recovery at 6 month after surgery. The decision tree analysis demonstrated that patients were expected to have a QSI ≥85% at 6 months after surgery if they met one of the following conditions: (1) age <23 years with a preoperative QSI ≥78.8%, (2) age ≥29 years with a preoperative QSI ≥98.0%, or (3) age <16 years with a preoperative QSI <58.5% and pre-injury Tegner activity scale ≥9. By contrast, patients ≥29 years with a preoperative QSI <98.0% were likely to achieve a quadriceps strength index <70% at 6 months after surgery.
Based on the results of the decision tree analysis, younger patients could achieve good quadriceps recovery even if they have a lower preoperative QSI, whereas patients ≥29 years need a higher preoperative QSI to obtain good muscle recovery.
患者人口统计学特征和伴随损伤的广泛差异使得预测哪些患者在前交叉韧带（ACL）重建后能快速恢复力量具有挑战性。本研究旨在确定自体腘绳肌腱ACL重建术后影响股四头肌力量恢复的主要因素，并使用决策树分析构建股四头肌力量恢复的预测模型。
本研究纳入了386例行自体腘绳肌腱ACL重建术的患者。术前及术后6个月测量60°/s等速股四头肌力量。股四头肌力量指数（QSI）通过将患侧腿的峰值扭矩与健侧腿的峰值扭矩进行归一化处理并乘以100来计算。进行逐步多元线性回归和决策树分析，以评估以下参数是否影响术后6个月的股四头肌力量恢复：社会人口统计学数据和最大等速股四头肌力量。
术前QSI、年龄和伤前Tegner活动量表与术后6个月的股四头肌力量恢复独立相关。决策树分析表明，如果患者符合以下条件之一，则预计术后6个月QSI≥85%：（1）年龄<23岁且术前QSI≥78.8%，（2）年龄≥29岁且术前QSI≥98.0%，或（3）年龄<16岁且术前QSI<58.5%且伤前Tegner活动量表≥9。相比之下，术前QSI<98.0%的≥29岁患者术后6个月股四头肌力量指数可能<70%。
基于决策树分析结果，年轻患者即使术前QSI较低也能实现良好的股四头肌恢复，而≥29岁的患者需要更高的术前QSI才能获得良好的肌肉恢复。
