Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.
J Bone Joint Surg Am. 2021 Aug 18;103(16):1473-1481. doi: 10.2106/JBJS.20.01731.
Anterior cruciate ligament (ACL) injuries can be treated with or without ACL reconstruction (ACLR), and more high-quality studies evaluating outcomes after the different treatment courses are needed. The purpose of the present study was to describe and compare 5-year clinical, functional, and physical activity outcomes for patients who followed our decision-making and treatment algorithm and chose (1) early ACLR with preoperative and postoperative rehabilitation, (2) delayed ACLR with preoperative and postoperative rehabilitation, or (3) progressive rehabilitation alone. Early ACLR was defined as that performed ≤6 months after the preoperative rehabilitation program, and late ACLR was defined as that performed >6 months after the preoperative rehabilitation program.
We included 276 patients from a prospective cohort study. The patients had been active in jumping, pivoting, and cutting sports before the injury and sustained a unilateral ACL injury without substantial concomitant knee injuries. The patients chose their treatment through a shared decision-making process. At 5 years, we assessed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, sports participation, quadriceps muscle strength, single-legged hop performance, and new ipsilateral and contralateral knee injuries.
The 5-year follow-up rate was 80%. At 5 years, 64% of the patients had undergone early ACLR, 11% had undergone delayed ACLR, and 25% had had progressive rehabilitation alone. Understandably, the choices that participants made differed by age, concomitant injuries, symptoms, and predominantly level-I versus level-II preinjury activity level. There were no significant differences in any clinical, functional, or physical activity outcomes among the treatment groups. Across treatment groups, 95% to 100% of patients were still active in some kind of sports and 65% to 88% had IKDC-SKF and KOOS scores above the threshold for a patient acceptable symptom state.
Patients with ACL injury who were active in jumping, pivoting, and cutting sports prior to injury; who had no substantial concomitant knee injuries; and who followed our decision-making and treatment algorithm had good 5-year knee function and high sport participation rates. Three of 4 patients had undergone ACLR within 5 years. There were no significant differences in any outcomes among patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
前交叉韧带（ACL）损伤可通过 ACL 重建（ACLR）或不进行 ACLR 进行治疗，需要更多高质量的研究来评估不同治疗方案后的结果。本研究的目的是描述和比较 5 年的临床、功能和身体活动结果，这些结果来自于根据我们的决策和治疗方案选择（1）早期 ACLR 加术前和术后康复，（2）延迟 ACLR 加术前和术后康复，或（3）单独进行渐进康复的患者。早期 ACLR 的定义为在术前康复计划后≤6 个月内进行，晚期 ACLR 的定义为在术前康复计划后>6 个月进行。
我们纳入了一项前瞻性队列研究中的 276 名患者。这些患者在受伤前曾参加过跳跃、旋转和切割运动，且单侧 ACL 损伤无明显合并膝关节损伤。患者通过共同决策过程选择治疗方案。在 5 年时，我们评估了国际膝关节文献委员会主观膝关节评分（IKDC-SKF）、膝关节损伤和骨关节炎结果评分（KOOS）、Marx 活动评分量表、运动参与度、股四头肌力量、单腿跳跃表现以及同侧和对侧新的膝关节损伤。
5 年随访率为 80%。5 年后，64%的患者进行了早期 ACLR，11%的患者进行了延迟 ACLR，25%的患者进行了单独的渐进康复。可以理解的是，参与者的选择因年龄、合并损伤、症状以及术前活动水平主要为 I 级或 II 级而有所不同。在任何临床、功能或身体活动结果方面，治疗组之间均无显著差异。在所有治疗组中，95%100%的患者仍在从事某种运动，65%88%的患者 IKDC-SKF 和 KOOS 评分高于可接受的患者症状状态阈值。
在受伤前参加过跳跃、旋转和切割运动、无明显合并膝关节损伤、遵循我们的决策和治疗方案的 ACL 损伤患者，在 5 年内膝关节功能良好，运动参与率高。4 名患者中有 3 名在 5 年内接受了 ACLR。接受早期 ACLR、延迟 ACLR 或单独渐进康复治疗的患者之间，在任何结果方面均无显著差异。
治疗水平 II。有关证据水平的完整描述，请参见作者说明。
