Emory University School of Medicine (B.L.Y., K.E.H.).
Arthroscopy. 2023 Jul;39(7):1690-1691. doi: 10.1016/j.arthro.2023.03.003.
Optimal timing of anterior cruciate ligament reconstruction (ACLR) remains under debate. Prolonging time between injury and ACLR risks damaging the meniscus and chondral surface, as well as delays return to play. Early ACLR may be associated with postoperative stiffness or arthrofibrosis. We emphasize that optimal timing for ACLR depends on criterion-based return of knee range of motion and quadriceps strength, not a quantitative temporal period. The length of time is far less important that the quality of prereconstruction care provided. Prereconstruction care includes "prehabilitation," including prone hangs focusing on optimizing knee range of motion, postinjury effusion resolution, and mentally preparing the patient for postoperative expectations. Defining preoperative criteria for proceeding with surgery is crucial to decrease the risk of arthrofibrosis. Some patients meet these criteria within 2 weeks, whereas others linger to 10 weeks. Reduction in arthrofibrosis requiring surgical intervention is multifactorial and not solely dependent on the length of time between injury and intervention.
前交叉韧带重建（ACLR）的最佳时机仍存在争议。受伤和 ACLR 之间的时间延长会增加半月板和软骨表面损伤的风险，并延迟恢复运动。早期 ACLR 可能与术后僵硬或关节纤维粘连有关。我们强调，ACLR 的最佳时机取决于基于标准的膝关节活动范围和股四头肌力量的恢复，而不是定量的时间周期。时间的长短远不如重建前护理的质量重要。重建前护理包括“预康复”，包括俯卧位悬挂，重点是优化膝关节活动范围、受伤后积液的消退，以及让患者为术后的预期做好心理准备。确定手术前的标准对于降低关节纤维粘连的风险至关重要。有些患者在 2 周内达到这些标准，而有些患者则需要 10 周。减少需要手术干预的关节纤维粘连是多因素的，并不完全取决于受伤和干预之间的时间长短。
