Török László, Jávor Péter, Török Katalin, Rárosi Ferenc, Hartmann Petra
Department of Sports Medicine, University of Szeged, Szeged, Hungary.
Department of Traumatology, University of Szeged, Szeged, Hungary.
Ann Rehabil Med. 2022 Apr;46(2):97-107. doi: 10.5535/arm.22010. Epub 2022 Apr 30.
To compare the outcomes of a 6-month-long accelerated rehabilitation with a 12-month-long rehabilitation. There is no consensus on the optimal duration of rehabilitation after anterior cruciate ligament reconstruction (ACLR). Trends in the past decades have shifted towards accelerated programs, often resulting in a return to play (RTP) at 4-6 months, postoperatively. However, longer rehabilitation cycles have recently experienced renaissance due to a greater understanding of graft remodeling.
Adult athletes who underwent ACLR between 2015 and 2018 by the same surgeon were included and followed-up prospectively for 24 months. Participants were allocated into two groups based on their RTP (6 months vs. 12 months) and compared with graft elongation, reoperation rate, and sports career (quit or continue) outcomes.
Fifty-four patients underwent accelerated rehabilitation and 92 completed conventional rehabilitation. The accelerated rehabilitation was significantly associated with graft elongation-the accelerated rehabilitation group (n=9) and the conventional rehabilitation group (n=0), p<0.001-and need for reoperation-the accelerated rehabilitation group (n=5) and the conventional rehabilitation group (n=1), p=0.026. Although the relationship between rehabilitation time and quitting competitive sports did not reach significance at 0.05 level (p=0.063), it was significant when p<0.1, thereby showing a clear trend.
Accelerated rehabilitation increased graft elongation risk. Knee laxity ≥3 mm measured at 6 months after ACLR should be accompanied by RTP time frame re-evaluation. Arthrometry checkups or routine magnetic resonance imaging shortly after RTP may be considered in cases of accelerated rehabilitation.
比较为期6个月的加速康复与为期12个月的康复效果。对于前交叉韧带重建（ACLR）术后的最佳康复时长，目前尚无共识。在过去几十年里，趋势已转向加速康复方案，术后通常在4至6个月就能恢复运动（RTP）。然而，由于对移植物重塑有了更深入的了解，较长的康复周期最近又重新受到青睐。
纳入2015年至2018年间由同一位外科医生进行ACLR的成年运动员，并对其进行为期24个月的前瞻性随访。根据恢复运动的时间（6个月与12个月）将参与者分为两组，并比较移植物伸长、再次手术率和运动生涯（退出或继续）结局。
54例患者接受了加速康复，92例完成了传统康复。加速康复与移植物伸长显著相关——加速康复组（n = 9）和传统康复组（n = 0），p < 0.001——以及再次手术需求——加速康复组（n = 5）和传统康复组（n = 1），p = 0.026。尽管康复时间与退出竞技运动之间的关系在0.05水平上未达到显著（p = 0.063），但在p < 0.1时具有显著性，从而显示出明显的趋势。
加速康复增加了移植物伸长的风险。ACLR术后6个月测得膝关节松弛度≥3 mm时，应重新评估恢复运动的时间框架。对于加速康复的情况，可考虑在恢复运动后不久进行关节测量检查或常规磁共振成像检查。
