University of Texas Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA.
Memorial Hermann's Ironman Sports Medicine Institute, Houston, Texas, USA.
Am J Sports Med. 2019 Sep;47(11):2550-2556. doi: 10.1177/0363546519863347. Epub 2019 Jul 26.
Loss of motion (LOM) remains a common complication after anterior cruciate ligament (ACL) reconstruction and can be detrimental to patient outcomes after surgery. LOM is multifactorial, but nonsurgical and surgical solutions to this complex problem are available. A paucity of quality data exists evaluating clinical outcomes after the surgical treatment of patients with LOM after ACL reconstruction.
Patients undergoing surgical lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction will exhibit decreased function, lower outcome scores, and delayed time of release to play when compared with matched controls without LOM.
Cohort study; Level of evidence, 3.
A database of 1572 patients undergoing ACL reconstruction was sampled from 2013 to 2017 to identify a total of 58 patients (LOM group [n = 29] vs matched control group [n = 29]). Group comparisons were examined for patients requiring a second surgical procedure for LOM versus matched controls after ACL reconstruction for differences in surgical timing, self-reported International Knee Disability Committee scores, objective function at release to play, and subjective knee function at 2 years with the Single Assessment Numeric Evaluation. The risk of a type I error was set at α = .05 for all statistical analyses.
Patients who underwent lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction exhibited no differences in Single Assessment Numeric Evaluation knee function at 2 years when compared with matched controls (85.8 ± 14.9 vs 88.0 ± 10.8, = .606). All patients met release-to-play criteria. Only International Knee Disability Committee scores ( = .046) and single-legged hop testing ( = .050) reached statistically significant differences, with higher scores in the control group. There was no difference in the time to release to play ( = .034) or level of participation ( = .180) between the control and surgical groups. Subjective function scores at 2 years were not significantly different between groups. Tourniquet time during the index ACL reconstruction was shorter in the control group ( = .034).
The findings of this study suggest that patients who undergo surgical treatment for LOM after ACL reconstruction can release to play at similar times but display relative deficits in single-legged-hop symmetry and lower self-reported function when compared with matched controls. Longer surgical times may increase the risk for LOM after ACL reconstruction.
NCT03704376 (ClinicalTrials.gov identifier).
在前交叉韧带（ACL）重建后，运动丧失（LOM）仍然是一种常见的并发症，并且会对手术后患者的预后产生不利影响。LOM 是多因素的，但对于这个复杂问题，有非手术和手术解决方案。目前，评估 ACL 重建后 LOM 患者手术后临床结果的高质量数据很少。
与无 LOM 的匹配对照组相比，接受 ACL 重建后 LOM 松解和麻醉下手法治疗的患者在功能、结局评分和重返赛场的时间上表现出降低。
队列研究；证据水平，3 级。
从 2013 年至 2017 年，对 1572 例接受 ACL 重建的患者进行数据库抽样，以确定总共 58 例患者（LOM 组[n=29]与匹配对照组[n=29]）。对需要进行第二次手术以治疗 LOM 的患者与接受 ACL 重建的匹配对照组进行组间比较，以评估手术时机、国际膝关节文献委员会评分、重返赛场时的客观功能以及 2 年时的单评估数字评估（Single Assessment Numeric Evaluation，SANE）膝关节功能的差异。所有统计分析的Ⅰ型错误风险设定为α=0.05。
与匹配对照组相比，接受 ACL 重建后 LOM 松解和麻醉下手法治疗的患者在 SANE 膝关节功能评分上，在 2 年时没有差异（85.8±14.9 比 88.0±10.8，=0.606）。所有患者均符合重返赛场标准。只有国际膝关节文献委员会评分（=0.046）和单腿跳跃测试（=0.050）达到统计学差异，对照组的评分更高。在重返赛场时间（=0.034）或参与水平（=0.180）方面，对照组和手术组之间没有差异。两组之间 2 年时的主观功能评分没有显著差异。在 ACL 重建的指数手术中，对照组的止血带时间更短（=0.034）。
本研究结果表明，接受 ACL 重建后 LOM 手术治疗的患者可以在相似的时间重返赛场，但与匹配对照组相比，单腿跳跃对称性和自我报告功能相对较差。较长的手术时间可能会增加 ACL 重建后 LOM 的风险。
NCT03704376（ClinicalTrials.gov 标识符）。
