La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
Br J Sports Med. 2022 Dec;56(24):1445-1453. doi: 10.1136/bjsports-2022-105495. Epub 2022 Jun 29.
Synthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes.
Overview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence.
MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library.
Systematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults.
We included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured individuals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength; (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function; (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function; and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively; (2) cryotherapy reduces pain and analgesic use; (3) psychological interventions improve anxiety/fear; and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size; (2) blood flow restriction training improves quadriceps size; (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function; and (4) continuous passive motion has no effect on range of motion.
The general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.
综合 ACL 和/或半月板撕裂后康复干预对症状、功能、临床、心理社会、生活质量和再损伤结果的有效性证据。
系统评价概述，使用推荐评估、制定和评估证据确定性分级。
MEDLINE、EMBASE、CINAHL、SPORTDiscus 和 Cochrane 图书馆。
针对 ACL 和/或年轻人半月板撕裂后康复干预的随机对照试验的系统评价。
我们纳入了 22 项系统评价（142 项主要为男性的试验），评估 ACL 损伤患者，无单独评估半月板损伤的研究。我们综合了 16 项评估 12 种不同干预措施的综述数据。观察到中等确定性证据：（1）神经肌肉电刺激可改善股四头肌力量；（2）开放式与闭合式动力链运动对股四头肌力量和自我报告功能同样有效；（3）结构化家庭康复与结构化门诊康复对股四头肌和腘绳肌力量和自我报告功能同样有效；（4）术后膝关节支具对身体功能和松弛度无效。有低确定性证据表明：（1）术前运动疗法可改善术后自我报告和身体功能；（2）冰敷可减轻疼痛和减少镇痛药使用；（3）心理干预可改善焦虑/恐惧；（4）全身振动可改善股四头肌力量。有极低确定性证据表明：（1）蛋白质补充剂可改善股四头肌大小；（2）血流限制训练可改善股四头肌大小；（3）神经肌肉控制练习可改善股四头肌和腘绳肌力量和自我报告功能；（4）持续被动运动对关节活动度无影响。
ACL 或半月板撕裂后康复的总体证据水平较低。中等确定性证据表明，几种康复类型可改善股四头肌力量，而支具使用对膝关节功能/松弛度无影响。
