Harter R A, Osternig L R, Singer K M, James S L, Larson R L, Jones D C
Department of Human Performance, San Jose State University, California 95192.
Am J Sports Med. 1988 Sep-Oct;16(5):434-43. doi: 10.1177/036354658801600502.
Currently used measures of knee stability and function for ACL reconstructed knees have not gained universal acceptance. Clinical test results often are given more value than the patient's subjective evaluation of the surgical outcome. This study was designed to identify specific knee stability and function variables that were most predictive of the patient's rating of knee function following one of two types of combined (intraarticular and extraarticular) ACL reconstruction procedures. Individual measures of knee stability and function were also evaluated for differences between contralateral operated and nonoperated limbs. Postoperative and healthy contralateral knees of 51 male and female patients aged 18 to 49 years (mean, 23.7 years) were evaluated on a battery of tests at an average of 48.0 months after surgery (range, 24 to 101 months). All subjects possessed a normal contralateral knee for comparative purposes. The results of this retrospective study indicated that the variables selected were not highly correlated with, nor could they effectively predict, the patients' perceptions of postoperative knee status as measured by the Knee Function Rating Form (KFR). Statistically significant differences (P less than 0.001) between operated and nonoperated knees were found for 9 of 11 variables analyzed. The data suggest that patients' perceptions of postoperative knee status were independent of the results of static and dynamic clinical tests commonly used to assess knee stability and function. Postoperative deficits of up to 30% between the surgically reconstructed and normal contralateral knees on specific measures of knee stability and function did not greatly influence the patients' perceptions of knee function. Development of new, more specific dynamic tests may be necessary before stronger relationships between clinical test results and patients' perceptions of knee status in the ACL reconstructed knee can be realized.
目前用于评估前交叉韧带（ACL）重建膝关节稳定性和功能的方法尚未得到广泛认可。临床测试结果往往比患者对手术效果的主观评价更受重视。本研究旨在确定在两种联合（关节内和关节外）ACL重建手术之一后，哪些特定的膝关节稳定性和功能变量最能预测患者对膝关节功能的评分。还评估了膝关节稳定性和功能的个体测量值在对侧手术肢体和未手术肢体之间的差异。对51名年龄在18至49岁（平均23.7岁）的男性和女性患者的术后膝关节以及健康对侧膝关节进行了一系列测试，平均术后48.0个月（范围为24至101个月）。为了进行比较，所有受试者的对侧膝关节均正常。这项回顾性研究的结果表明，所选择的变量与通过膝关节功能评分表（KFR）测量的患者对术后膝关节状况的认知之间没有高度相关性，也不能有效地预测这种认知。在分析的11个变量中，有9个在手术膝关节和未手术膝关节之间发现了具有统计学意义的差异（P小于0.001）。数据表明，患者对术后膝关节状况的认知独立于通常用于评估膝关节稳定性和功能的静态和动态临床测试结果。在特定的膝关节稳定性和功能测量指标上，手术重建膝关节与正常对侧膝关节之间高达30%的术后缺陷并未对患者的膝关节功能认知产生太大影响。在实现临床测试结果与ACL重建膝关节患者对膝关节状况的认知之间更强的关系之前，可能需要开发新的、更具特异性的动态测试。
