Hanada Mitsuru, Yoshikura Takanori, Matsuyama Yukihiro
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
Department of Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Eur J Orthop Surg Traumatol. 2019 Dec;29(8):1759-1764. doi: 10.1007/s00590-019-02479-3. Epub 2019 Jun 25.
The anterior cruciate ligament (ACL) injury often occurs in young athletes, but it also occurs in middle-aged individuals and the elderly during recreational sports activities. Clinical outcomes after the ACL reconstruction depend on postoperative recovery of muscular strength. The current study aimed to evaluate the recovery of knee extension and flexion strength after ACL reconstruction surgery and to examine the relationship between preoperative and postoperative muscle strength by age and the type of graft used.
From 2007 to 2010, 32 patients (17 men, 15 women; average age, 31 years; range, 14-66 years) who underwent two-bundle ACL reconstruction surgery using hamstrings, i.e., semitendinous and gracilis tendon (STG) graft, and 25 patients (15 men, 10 women; average age, 28 years; range, 15-59 years) who underwent the ACL reconstruction surgery using bone-patellar tendon-bone (BTB) graft were included in this study. The muscular strength of the knee extension and flexion compared to non-injury side was measured by an isokinetic dynamometer at a velocity at 60°/s preoperatively, and postoperative measurements were performed at 6, 9 months, and 1 year after the ACL reconstruction surgery.
Covariates that influenced the outcome of the force of knee extension at 12 months were the preoperative muscular strength [p = 0.045, odds ratio (OR): 1.105, 95% confidence interval (CI): 1.002-1.219] and muscular strength at 6 months after surgery (p = 0.040, OR: 1.155, 95% CI: 1.006-1.326). Only muscle strength at 6 months after surgery influenced the outcome of the force of the knee flexion at 1 year after surgery. In sub-analysis, muscular strength of the knee extension and flexion was greater in the STG group than in the BTB group at 6 months after surgery although there was no difference between muscular strength of the knee extension in the STG group and that in BTB group at 1 year.
Recovery of knee extension strength at a year after ACL reconstruction was significantly associated with preoperative muscular strength and muscle recovery at 6 months. Age and graft type might be related to the muscle strength recovery. Preoperative and early postoperative strength training could improve the recovery of knee extension strength, which would support an earlier return to sports after ACL reconstruction.
前交叉韧带（ACL）损伤常发生于年轻运动员，但在中年人和老年人进行娱乐性体育活动时也会出现。ACL重建术后的临床结果取决于术后肌肉力量的恢复情况。本研究旨在评估ACL重建手术后膝关节屈伸力量的恢复情况，并按年龄和所使用移植物的类型研究术前和术后肌肉力量之间的关系。
2007年至2010年，本研究纳入了32例患者（17例男性，15例女性；平均年龄31岁；范围14 - 66岁），这些患者采用绳肌，即半腱肌和股薄肌腱（STG）移植物进行双束ACL重建手术；以及25例患者（15例男性，10例女性；平均年龄28岁；范围15 - 59岁），这些患者采用骨 - 髌腱 - 骨（BTB）移植物进行ACL重建手术。术前使用等速测力计以60°/s的速度测量患侧膝关节屈伸与未受伤侧相比的肌肉力量，术后在ACL重建手术后6个月、9个月和1年进行测量。
影响术后12个月膝关节伸展力结果的协变量为术前肌肉力量[p = 0.045，优势比（OR）：1.105，95%置信区间（CI）：1.002 - 1.219]和术后6个月的肌肉力量（p = 0.040，OR：1.155，95%CI：1.006 - 1.326）。仅术后6个月的肌肉力量影响术后1年膝关节屈曲力的结果。在亚组分析中，术后6个月时STG组膝关节屈伸的肌肉力量大于BTB组，尽管术后1年时STG组膝关节伸展的肌肉力量与BTB组之间无差异。
ACL重建术后1年膝关节伸展力量的恢复与术前肌肉力量及术后6个月的肌肉恢复显著相关。年龄和移植物类型可能与肌肉力量恢复有关。术前和术后早期进行力量训练可改善膝关节伸展力量的恢复，这将有助于ACL重建术后更早恢复运动。
