Sonkodi Balázs, Varga Endre, Hangody László, Poór Gyula, Berkes István
Department of Health Sciences and Sport Medicine, University of Physical Education, Budapest, Hungary.
Department of Traumatology, University of Szeged, Szeged, Hungary.
BMC Sports Sci Med Rehabil. 2021 Nov 25;13(1):149. doi: 10.1186/s13102-021-00377-y.
Anterior cruciate ligament injury arises when the knee anterior ligament fibers are stretched, partially torn, or completely torn. Operated patients either end up re-injuring their reconstructed anterior cruciate ligament or majority develop early osteoarthritis regardless of the remarkable improvements of surgical techniques and the widely available rehabilitation best practices. New mechanism theories of non-contact anterior cruciate ligament injury and delayed onset muscle soreness could provide a novel perspective how to respond to this clinical challenge.
A tri-phasic injury model is proposed for these non-contact injuries. Mechano-energetic microdamage of the proprioceptive sensory nerve terminals is suggested to be the first-phase injury that is followed by a harsher tissue damage in the second phase. The longitudinal dimension is the third phase and that is the equivalent of the repeated bout effect of delayed onset muscle soreness. Current paper puts this longitudinal injury phase into perspective as the phase when the long-term memory consolidation and reconsolidation of this learning related neuronal injury evolves and the phase when the extent of the neuronal regeneration is determined. Reinstating the mitochondrial energy supply and 'breathing capacity' of the injured proprioceptive sensory neurons during this period is emphasized, as avoiding fatigue, overuse, overload and re-injury.
Extended use, minimum up to a year or even longer, of a current rehabilitation technique, namely moderate intensity low resistance stationary cycling, is recommended preferably at the end of the day. This exercise therapeutic strategy should be a supplementation to the currently used rehabilitation best practices as a knee anti-aging maintenance effort.
当膝关节前韧带纤维被拉伸、部分撕裂或完全撕裂时，会发生前交叉韧带损伤。尽管手术技术有了显著改进且广泛采用了最佳康复方法，但接受手术的患者最终要么再次损伤重建的前交叉韧带，要么大多数人会发展为早期骨关节炎。非接触性前交叉韧带损伤和延迟性肌肉酸痛的新机制理论可能为应对这一临床挑战提供新的视角。
针对这些非接触性损伤，提出了一种三相损伤模型。本体感觉感觉神经末梢的机械能量微损伤被认为是第一阶段损伤，随后在第二阶段会出现更严重的组织损伤。纵向维度是第三阶段，这相当于延迟性肌肉酸痛的重复发作效应。本文将这个纵向损伤阶段视为与学习相关的神经元损伤的长期记忆巩固和重新巩固发展的阶段，以及确定神经元再生程度的阶段。在此期间，强调恢复受损本体感觉感觉神经元的线粒体能量供应和“呼吸能力”，同时避免疲劳、过度使用、过载和再次受伤。
建议在一天结束时，最好延长使用目前的康复技术，即中等强度低阻力固定自行车运动，最短使用一年甚至更长时间。这种运动治疗策略应作为膝关节抗衰老维护措施，补充目前使用的最佳康复方法。
