Shelbourne K Donald, Benner Rodney, Gray Tinker, Bauman Scot
Shelbourne Knee Center, Indianapolis, Indiana, USA.
Orthop J Sports Med. 2022 Nov 29;10(11):23259671221138103. doi: 10.1177/23259671221138103. eCollection 2022 Nov.
BACKGROUND: Regaining preinjury levels of activity and progressing rehabilitation factors after anterior cruciate ligament (ACL) reconstruction have shown mixed results. PURPOSE: To evaluate the timing and rate of return for knee range of motion (ROM), stability, strength, and subjective scores after ACL reconstruction with contralateral patellar tendon graft (PTG). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Included were 2148 patients (1238 male patients, 910 female patients) who underwent primary ACL reconstruction with a contralateral PTG between 1995 and 2017 and had complete objective data through 3 months of follow-up. All patients participated in a rehabilitation program specific to goals for each knee. Patients were evaluated objectively with goniometric measurement of ROM, isokinetic quadriceps strength testing, and laxity with a KT-2000 arthrometer. Subjective data were collected at 2 and 5 years. RESULTS: Normal extension on the reconstructed knee was attained for 95% of patients at 1 week postoperatively; normal flexion on the reconstructed knee was reached by 77% of patients by 3 months. At 3 months postoperatively, mean limb symmetry index strength was 104%, and the strength on the ACL-reconstructed and graft-donor knees was 87% and 86% of their respective preoperative strength. Mean manual maximum side-to-side difference in laxity was 2.0 mm at 1 month. Most patients (90%) returned to level 8 sports or higher and did so at an average of 5.7 months. Mean International Knee Documentation Committee scores for the ACL-reconstructed and graft-donor knees were 89 and 91 at 2 years (n = 1015 patients) and 84 and 90 at 5 years (n = 1275 patients), respectively. Mean Cincinnati Knee Rating Scale scores for the ACL-reconstructed and graft-donor knees were 92 and 96 at 2 years (n = 1184) and 88 and 94 at 5 years (n = 1236), respectively. CONCLUSION: For patients who underwent ACL reconstruction with a contralateral PTG, postoperative ROM and strength were restored quickly by splitting the rehabilitation into different goals between the two knees. Using a contralateral PTG, this structured rehabilitation plan can lead to a relatively quick return to sport and good subjective long-term outcomes.
背景：前交叉韧带（ACL）重建术后恢复到伤前的活动水平以及康复进程相关因素的研究结果不一。 目的：评估采用对侧髌腱移植（PTG）进行ACL重建术后膝关节活动范围（ROM）、稳定性、力量及主观评分的恢复时间和恢复率。 研究设计：病例系列；证据等级，4级。 方法：纳入1995年至2017年间采用对侧PTG进行初次ACL重建且有完整3个月随访客观数据的2148例患者（男性1238例，女性910例）。所有患者均参与了针对每个膝关节目标的康复计划。通过量角器测量ROM、等速股四头肌力量测试以及使用KT - 2000关节测量仪测量松弛度对患者进行客观评估。在2年和5年时收集主观数据。 结果：术后1周，95%的患者重建膝关节达到正常伸直；术后3个月，77%的患者重建膝关节达到正常屈曲。术后3个月，平均肢体对称指数力量为104%，ACL重建膝关节和移植物供体膝关节的力量分别为各自术前力量的87%和86%。术后1个月，平均手动最大左右侧松弛度差异为2.0毫米。大多数患者（90%）恢复到8级或更高水平的运动，平均恢复时间为5.7个月。2年时（n = 1015例患者），ACL重建膝关节和移植物供体膝关节的国际膝关节文献委员会平均评分分别为89分和91分；5年时（n = 1275例患者），分别为84分和90分。2年时（n = 1184例），ACL重建膝关节和移植物供体膝关节的辛辛那提膝关节评分量表平均评分分别为92分和96分；5年时（n = 1236例），分别为88分和94分。 结论：对于采用对侧PTG进行ACL重建的患者，通过将康复分为两个膝关节的不同目标，术后ROM和力量恢复迅速。采用对侧PTG，这种结构化的康复计划可使患者相对较快地恢复运动，并获得良好的主观长期效果。
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