Fitz Wolfgang, Shukla Pinak, Li Ling, Scott Richard D
Research performed at New England Baptist Hospital, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA.
Great Plains Orthopedics, North Platte, NE, USA.
Arch Bone Jt Surg. 2018 Nov;6(6):523-531.
Techniques that allow early muscle activation, such as closed kinetic chain (CKC) and open kinetic chain (OKC) exercises, may play a beneficial role in the early rehabilitation of the reconstructed knee. However, current rehabilitation regimens have not been shown to reverse post-operative quadriceps activation failure and weakness. To investigate whether patients who use a continuous active motion (CAM) device that follows closed kinetic chain principles have better early post-operative functional improvements than patients who use a continuous passive motion (CPM) device that follows the principles of open kinetic chain principles. A prospective randomized controlled trial with non-blinded study staff. A tertiary care clinic at a teaching hospital. A total of 110 patients signed the consent form and 83 patients participated in the study.
Patients were randomly assigned to use either the CPM device for 4 hours daily for 3 weeks (control group), or a CAM device for 3 sessions of 20 minutes for 3 weeks (intervention group), starting 24 hours after knee replacement surgery.The primary outcome measure was to identify the superiority, inferiority, or equivalence of one device at week 4 after knee arthroplasty using various functional outcome measures such as kinesthesia, quadriceps strength, coordination, general orthopaedic outcome measures and narcotic consumption.
At 4 weeks, all outcome measurements were comparable between the two groups, with the exception of sit-to-stand test: in the treatment group the time was significantly shorter compared to the control group (). Balance was significantly better in both control () and treatment group () compared to prior surgery.
Most clinical centers would like to expedite functional recovery of knee arthroplasty patients without increasing the risk of falls. We observed balance and kinesthesia improvements after surgery using either device which may be important to benefit fast recovery programs. Further research is warranted to see whether additional active closed kinetic chain exercised following knee replacement surgery could improve specific functional outcomes such the observed sit-to-stand test.
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允许早期肌肉激活的技术，如闭链运动（CKC）和开链运动（OKC）练习，可能在重建膝关节的早期康复中发挥有益作用。然而，目前的康复方案尚未显示能逆转术后股四头肌激活失败和无力的情况。为了研究使用遵循闭链运动原则的持续主动运动（CAM）装置的患者与使用遵循开链运动原则的持续被动运动（CPM）装置的患者相比，术后早期功能改善是否更好。这是一项由非盲研究人员进行的前瞻性随机对照试验。研究地点为一家教学医院的三级护理诊所。共有110名患者签署了知情同意书，83名患者参与了研究。
患者被随机分配，从膝关节置换手术后24小时开始，每天使用CPM装置4小时，持续3周（对照组），或使用CAM装置，每次20分钟，共3次，持续3周（干预组）。主要结局指标是在膝关节置换术后第4周，使用各种功能结局指标，如运动觉、股四头肌力量、协调性、一般骨科结局指标和麻醉药物消耗量，来确定一种装置相对于另一种装置的优越性、劣势或等效性。
在第4周时，除坐立试验外，两组的所有结局测量指标均具有可比性：治疗组的时间明显短于对照组（）。与术前相比，对照组（）和治疗组（）的平衡能力均明显更好。
大多数临床中心希望在不增加跌倒风险的情况下加快膝关节置换患者的功能恢复。我们观察到，使用这两种装置中的任何一种进行手术后，平衡和运动觉都有所改善，这对于快速康复计划可能很重要。有必要进一步研究，以确定膝关节置换术后额外的主动闭链运动是否能改善特定的功能结局，如观察到的坐立试验。
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