Naik Arjun Ajith, Das Bishwaranjan, Kamat Yogeesh D
Department of Orthopaedics, KMC Hospital, Mangalore, India.
Department of Physiotherapy, KMC Hospital, Mangalore, India.
Eur J Orthop Surg Traumatol. 2019 Dec;29(8):1743-1747. doi: 10.1007/s00590-019-02521-4. Epub 2019 Jul 26.
It has been quoted that the graft is more prone to injury in the early stages of ligamentization between 3 and 6 months when the muscles are weak and compliance with post-op protocol is waning. Purpose of this study was to evaluate the functional outcome of avoiding postoperative bracing following ACL reconstruction and early enhanced recovery protocol on the reinjuries of graft.
Thirty-two consecutive patients who underwent arthroscopic ACL reconstruction by a single surgeon in the same specialist center between October 2015 and May 2017 were included in the study. All the patients were educated regarding rehabilitation before the index surgery and preoperative quadriceps exercises had been initiated. Rehabilitation was undertaken as per a standard protocol with emphasis on early mobilization. No brace was used. Patients were followed up between 3 months and 1 year. Lysholm knee scores were evaluated at 6 and 12 months postoperatively.
No failures were noted (failure defined as instability, stiffness or persistent pain). The average Lysholm knee score at 6 months was 88 and at 12 months period was 91. No statistical significance (P > 0.00001) was noted in the scores between braced and unbraced at 1 year.
ACL rehabilitation without a knee brace can indirectly prevent rerupture and is a cheaper as well as a safer method with better outcomes.
有观点认为，在韧带化的早期阶段，即术后3至6个月，当肌肉力量较弱且对术后康复方案的依从性下降时，移植韧带更容易受到损伤。本研究的目的是评估前交叉韧带重建术后避免使用支具以及早期强化康复方案对移植韧带再损伤的功能结局。
本研究纳入了2015年10月至2017年5月期间在同一专科中心由同一位外科医生连续进行关节镜下前交叉韧带重建的32例患者。所有患者在初次手术前均接受了康复教育，并已开始术前股四头肌锻炼。康复按照标准方案进行，重点是早期活动。未使用支具。对患者进行了3个月至1年的随访。术后6个月和12个月评估Lysholm膝关节评分。
未观察到失败病例（失败定义为不稳定、僵硬或持续疼痛）。6个月时的平均Lysholm膝关节评分为88分，12个月时为91分。1年时，使用支具和未使用支具的患者评分之间无统计学意义（P＞0.00001）。
不使用膝关节支具进行前交叉韧带康复可以间接预防再次断裂，是一种更便宜、更安全且效果更好的方法。
