Zhang Shurong, Wen Aizhen, Li Shengkun, Yao Wei, Liu Chang, Lin Zifan, Jin Zhengbiao, Chen Jiwu, Hua Yinghui, Chen Shiyi, Li Yunxia
Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
Orthop J Sports Med. 2023 Feb 2;10(9):23259671221116340. doi: 10.1177/23259671221116340. eCollection 2022 Sep.
Graft maturation is an important prognostic factor for hamstring autograft anterior cruciate ligament reconstruction (ACLR). It remains unclear whether extracorporeal shock wave therapy (ESWT) can promote graft healing after ACLR.
To evaluate the therapeutic and graft maturation effects of ESWT in hamstring autograft ACLR.
Randomized controlled trial; Level of evidence, 1.
Between May 18, 2019, and September 20, 2019, we randomly assigned 30 patients who met study inclusion criteria to 2 groups. Patients in the control group followed a 5-week advanced rehabilitation training program (30 minutes/session, 5 times/week) starting at 3 months postoperatively. In the ESWT group, together with the 5-week advanced rehabilitation training, radial ESWT was applied once a week for 5 weeks. Functional scores (Lysholm, International Knee Documentation Committee, and Tegner scores), KT-1000 arthrometer knee laxity measurement, and magnetic resonance imaging scans were assessed at 3 months (baseline), 6 months, and 24 months postoperatively. To evaluate graft maturation, we assessed the graft signal-to-noise quotients (SNQs) of the tibial, intra-articular, and femoral sides on magnetic resonance imaging scans. Data were compared between the ESWT and control groups.
In total, 26 patients (13 with ESWT, 13 controls) were assessed. There were no significant between-group differences on any assessment at baseline, and no significant within-group or between-group differences were found in knee laxity at any point. At 24-month follow-up, the ESWT group had significantly higher Lysholm and Tegner scores compared with the controls ( = .012 and .017, respectively). Regarding graft maturation, at 6-month follow-up, the SNQ of the tibial intraosseous graft was significantly lower in the ESWT group versus controls ( = .006), but no differences were detected at the femoral intraosseous graft ( = .321) or the intra-articular graft ( = .314). At 24-month follow-up, the SNQs of the femoral intraosseous graft and intra-articular graft were significantly lower in the ESWT group versus controls ( = .020 and .044, respectively) but no difference was found at the tibial intraosseous graft ( = .579).
Both enhanced graft maturation and improved functional scores at 24-month follow-up were seen in patients who received radial ESWT during rehabilitation after hamstring autograft ACLR.
ChiCTR1900022853 (Chinese Clinical Trial Registry).
移植物成熟是自体腘绳肌肌腱前交叉韧带重建术（ACLR）的一个重要预后因素。体外冲击波疗法（ESWT）能否促进ACLR术后移植物愈合仍不清楚。
评估ESWT对自体腘绳肌肌腱ACLR的治疗效果及移植物成熟情况。
随机对照试验；证据等级：1级。
在2019年5月18日至2019年9月20日期间，我们将30例符合研究纳入标准的患者随机分为两组。对照组患者在术后3个月开始进行为期5周的强化康复训练计划（每次30分钟，每周5次）。在ESWT组，除了5周的强化康复训练外，每周进行1次径向ESWT治疗，共5周。在术后3个月（基线）、6个月和24个月时评估功能评分（Lysholm评分、国际膝关节文献委员会评分和Tegner评分）、KT-1000膝关节测压仪测量的膝关节松弛度以及磁共振成像扫描。为了评估移植物成熟情况，我们在磁共振成像扫描中评估胫骨侧、关节内和股骨侧移植物的信号噪声比（SNQ）。比较ESWT组和对照组的数据。
总共评估了26例患者（ESWT组13例，对照组13例）。基线时两组在任何评估中均无显著差异，在任何时间点膝关节松弛度的组内或组间均无显著差异。在24个月的随访中，ESWT组的Lysholm评分和Tegner评分显著高于对照组（分别为P = 0.012和0.017）。关于移植物成熟情况，在6个月的随访中，ESWT组胫骨骨内移植物的SNQ显著低于对照组（P = 0.006），但在股骨骨内移植物（P = 0.321）或关节内移植物（P = 0.314）中未检测到差异。在24个月的随访中，ESWT组股骨骨内移植物和关节内移植物的SNQ显著低于对照组（分别为P = 0.020和0.044），但在胫骨骨内移植物中未发现差异（P = 0.579）。
在自体腘绳肌肌腱ACLR术后康复期间接受径向ESWT治疗的患者中，24个月随访时移植物成熟得到增强，功能评分得到改善。
ChiCTR1900022853（中国临床试验注册中心）
