Laboute E, Verhaeghe E, Ucay O, Minden A
C.E.R.S, Ramsay Générale de Santé, 83 av Maréchal de Lattre de Tassigny, 40130 Capbreton, Capbreton, France.
Université Catholique de Louvain, Place P. de Coubertin, 1348, Louvain-la-Neuve, Belgium.
J Exp Orthop. 2019 Feb 7;6(1):6. doi: 10.1186/s40634-019-0174-8.
The objective of this study was to evaluate kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in two populations of athletes, those in the post-surgery period and those in re-training during the intensive program-training phase.
We performed a prospective study in ACL-operated athletes without previous knee injuries, with 32 athletes in each group. Time since surgery in the operated athletes in the post-surgery group was 21 to 35 days, and between three and 9 months in the re-training group. We also analysed a control group of 32 uninjured non-operated subjects with a similar sporting level. Proprioception was evaluated using the threshold to detection of passive motion (TDPM) test with Biodex-type isokinetic equipment comparing operated knees, non-operated knees and control uninjured non-operated group. The control group was tested twice, 1 day apart to control reproducibility, using the intraclass correlation coefficient (ICC). The p-value threshold for statistical significance between different groups in hypothesis testing was <.05.
TDPM reproducibility was excellent (right knee: ICC = 0.80, left knee: ICC =0.72). We found a bilateral kinaesthetic deficit in post-surgery patients compared to the control group (p < 0.001 and p = 0.011), which was significantly higher on the operated side (p = 0.001). Re-training patients had no significant difference between operated and uninjured knees, but had a kinaesthetic deficit on operated limbs (p = 0.036) compared to the control group.
There was a bilateral deficit in post-surgery athletes with a significant difference between injured and healthy knees, which could be explained by a change in the central nervous system. Compared to the control group, a proprioceptive deficit was only seen for re-training patients on the operated side and not in the healthy limb. Kinaesthetic recovery may be faster for the uninjured side as initial deficit is lower. Level of evidence II.
本研究的目的是评估两类运动员群体在膝关节前交叉韧带（ACL）重建术后的本体感觉缺陷，一类是处于术后阶段的运动员，另一类是在强化项目训练阶段重新训练的运动员。
我们对既往无膝关节损伤且接受过ACL手术的运动员进行了一项前瞻性研究，每组32名运动员。术后组接受手术的运动员术后时间为21至35天，重新训练组为3至9个月。我们还分析了一个由32名未受伤、未接受手术且运动水平相似的受试者组成的对照组。使用Biodex型等速设备通过被动运动检测阈值（TDPM）测试来评估本体感觉，比较手术侧膝关节、非手术侧膝关节和对照组未受伤未手术组。对照组进行了两次测试，间隔1天以控制可重复性，使用组内相关系数（ICC）。假设检验中不同组之间具有统计学意义的p值阈值为<.05。
TDPM的可重复性极佳（右膝：ICC = 0.80，左膝：ICC = 0.72）。我们发现，与对照组相比，术后患者存在双侧本体感觉缺陷（p < 0.001和p = 0.011），手术侧的缺陷明显更高（p = 0.001）。重新训练组患者手术侧膝关节与未受伤膝关节之间无显著差异，但与对照组相比，手术侧肢体存在本体感觉缺陷（p = 0.036）。
术后运动员存在双侧缺陷，受伤膝关节与健康膝关节之间存在显著差异，这可能是由中枢神经系统的变化所解释。与对照组相比，重新训练组患者仅在手术侧存在本体感觉缺陷，健康肢体未出现。由于初始缺陷较低，未受伤侧的本体感觉恢复可能更快。证据等级为II级。
