前交叉韧带重建术前康复对重返运动相关和自我报告膝关节功能影响的证据：系统评价。
Evidence for the effects of prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee function: A systematic review.
机构信息
Division of Preventive and Sports Medicine, Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt/Main, Germany.
Department of Sports Medicine & Exercise Physiology, Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt/Main, Germany.
出版信息
PLoS One. 2020 Oct 28;15(10):e0240192. doi: 10.1371/journal.pone.0240192. eCollection 2020.
STUDY DESIGN
Systematic review.
BACKGROUND AND OBJECTIVES
Preoperative neuromuscular function is predictive for knee function and return to sports (RTS) after reconstruction of the anterior cruciate ligament (ACL). The aim of this review was to examine the potential benefits of prehabilitation on pre-/postoperative objective, self-reported and RTS-specific outcomes.
METHODS
A systematic search was conducted within three databases. From the 1.071 studies screened, two randomized control trials (RCTs), two control trials (CTs) and two cohort studies (CS) met the inclusion criteria. Methodological quality rating adopted the PEDro- (RCT, CT) or Newcastle-Ottawa-Scale (CS).
RESULTS AND CONCLUSIONS
Methodological quality of the included studies was moderate (PEDro score: 6.5 ± 1.7; range 4 to 9). Two studies reported higher increases of the maximal quadriceps torque from baseline to pre-reconstruction: one study in the limb symmetry index (LSI), and one in both legs of the prehabilitation group compared to the controls. At 12-weeks post-reconstruction, one study (from two) indicated that the prehabilitation group had a lesser post-operative decline in the single-leg-hop for distance LSI (clinically meaningful). Similar findings were found in terms of quadriceps strength LSI (one study). At both pre-reconstruction (three studies) and two-year post-surgery (two studies), the prehabilitation groups reached significantly higher self-reported knee function (clinically meaningful) than the controls. RTS tended to be faster (one study). At two years post-surgery, RTS rates (one study) were higher in the prehabilitation groups. The results provide evidence for the relevance of prehabilitation prior to ACL-reconstruction to improve neuromuscular and self-reported knee function as well as RTS. More high quality confirmatory RCTs are warranted.
REGISTRATION NUMBER
PROSPERO 2017: CRD42017065491.
研究设计
系统评价。
背景和目的
术前神经肌肉功能可预测前交叉韧带（ACL）重建后的膝关节功能和重返运动（RTS）。本综述的目的是检查术前康复对术前/术后客观、自我报告和 RTS 特异性结果的潜在益处。
方法
在三个数据库中进行了系统搜索。从筛选出的 1071 项研究中，有两项随机对照试验（RCT）、两项对照试验（CT）和两项队列研究（CS）符合纳入标准。采用 PEDro 量表（RCT、CT）或纽卡斯尔-渥太华量表（CS）对纳入研究的方法学质量进行评分。
结果和结论
纳入研究的方法学质量为中等（PEDro 评分：6.5±1.7；范围 4 至 9）。两项研究报告了从基线到重建前最大股四头肌扭矩的更高增加：一项研究在肢体对称性指数（LSI）中，另一项研究在预康复组的两条腿中均高于对照组。在重建后 12 周，一项研究（来自两项研究）表明预康复组在单腿跳距离 LSI 上术后下降较小（有临床意义）。在股四头肌力量 LSI 方面也有类似的发现（一项研究）。在重建前（三项研究）和手术后两年（两项研究），预康复组的自我报告膝关节功能（有临床意义）均显著高于对照组。RTS 往往更快（一项研究）。在手术后两年，预康复组的 RTS 率（一项研究）较高。结果为 ACL 重建前进行康复以改善神经肌肉和自我报告的膝关节功能以及 RTS 提供了证据。需要更多高质量的确认性 RCT 来证实。
注册号
PROSPERO 2017：CRD42017065491。
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