Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5 80130, Naples, Italy.
J Orthop Surg Res. 2022 Mar 9;17(1):153. doi: 10.1186/s13018-022-03049-w.
Postoperative rehabilitation after extensor mechanism reconstruction (EMR) with allograft following total knee arthroplasty (TKA) is not standardized. This meta-analysis aimed to evaluate the effectiveness of early and late knee mobilization after EMR. The range of motion (ROM) and extensor lag in both groups were also assessed as the secondary endpoint.
Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed, including studies dealing with the use of allograft for EMR following TKA. Failure was defined as the persistence of extensor lag > 20°. Coleman Methodology Score and Methodological Index for Non-Randomized Studies (MINORS) score were used to assess the quality of studies included. The failure rate was set as the primary outcome in early (4 weeks) and late (8 weeks) mobilization groups after EMR with allograft. Secondary outcomes were postoperative extensor lag and ROM.
Twelve articles (129 knees) were finally selected for this meta-analysis. Late and early knee mobilization was described in five and seven studies, respectively. No difference was noted between both groups' failure rates (11/84 vs. 4/38, respectively; p = 0.69). The mean extensor lag at last follow-up was 9.1° ± 8.6 in the early mobilization group, and 6.5° ± 6.1 in the late mobilization group is not significantly different (p > 0.05). The mean postoperative knee flexion was 107.6° ± 6.5 and 104.8° ± 7 in the early and late mobilization group, respectively.
While immobilization after EMR in TKA is mandatory to allow tissue healing, early knee mobilization after four weeks can be recommended with no additional risk of failure and increased extensor lag compared to a late mobilization protocol.
IV, therapeutic study. Registration PROSPERO (International Prospective Register of Systematic Reviews): CRD42019141574.
全膝关节置换术（TKA）后，同种异体伸肌重建（EMR）后的术后康复尚未标准化。本荟萃分析旨在评估 EMR 后早期和晚期膝关节活动度的效果。两组的关节活动度（ROM）和伸肌滞后也作为次要终点进行评估。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对涉及 TKA 后同种异体移植物用于 EMR 的文献进行了系统评价。失败定义为伸肌滞后>20°。使用 Coleman 方法评分和非随机研究方法学指数（MINORS）评分评估纳入研究的质量。将同种异体移植物 EMR 后早期（4 周）和晚期（8 周）活动组的失败率设定为主要结局。次要结局为术后伸肌滞后和 ROM。
最终有 12 篇文章（129 膝）纳入本荟萃分析。5 篇和 7 篇研究分别描述了晚期和早期膝关节活动度。两组的失败率无差异（分别为 11/84 与 4/38，p=0.69）。早期活动组末次随访时的平均伸肌滞后为 9.1°±8.6，晚期活动组为 6.5°±6.1，差异无统计学意义（p>0.05）。早期和晚期活动组的术后膝关节屈曲度分别为 107.6°±6.5 和 104.8°±7。
虽然 TKA 后 EMR 后必须固定以允许组织愈合，但在 4 周后早期膝关节活动度可以得到推荐，与晚期活动方案相比，失败风险增加和伸肌滞后增加的风险没有增加。
IV，治疗研究。PROSPERO（国际系统评价注册中心）注册：CRD42019141574。
