手术导致的肌腱断裂的治疗时机：骨-髌腱-骨自体移植物重建前交叉韧带后，髌腱移植物部位的早期肥大预示着强大的股四头肌。
Time to treat the tendon rupture induced by surgery: early hypertrophy of the patellar tendon graft site predicts strong quadriceps after ACLR with bone-patellar tendon-bone autograft.
机构信息
Biomechanics and Movement Science Program, University of Delaware, 540 S. College Ave, Newark, DE, 19713, USA.
Department of Physical Therapy, University of Delaware, Newark, DE, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5791-5798. doi: 10.1007/s00167-023-07657-9. Epub 2023 Nov 7.
PURPOSE
Quadriceps dysfunction is ubiquitous after anterior cruciate ligament reconstruction, especially when using bone-patellar tendon-bone (BPTB) autografts. The role of patellar tendon hypertrophy after graft harvest on knee extensor strength is unknown. The purpose of this study was to determine the predictive ability of patellar tendon (PT) and quadriceps muscle (Quad) cross-sectional area (CSA) on knee extensor strength 1-2 months after ACLR using BPTB autografts.
METHODS
This is a cross-sectional analysis of a cohort 1-2 months after ACLR using BPTB autograft. Peak knee extensor torque, and PT and Quad CSA measured using ultrasound imaging, were collected in 13 males and 14 females. Simple linear regressions compared quadriceps strength index (QI) against limb symmetry index (LSI) in PT and Quad CSA. Multiple linear regressions with sequential model comparisons predicting peak knee extensor torque were performed for each limb. The base model included demographics. Quad CSA was added in the first model, then PT CSA was added in the second model.
RESULTS
Both PT (p < 0.001, R = 0.693) and Quadriceps CSA (p = 0.013, R = 0.223) LSI had a positive linear relationship with QI. In the involved limb, addition of PT CSA significantly improved the model (R = 0.781, ΔR = 0.211, p for ΔR < 0.001). In the uninvolved limb, the addition of Quad CSA improved the model, but the addition of PT CSA did not.
CONCLUSION
PT LSI was more predictive of QI than Quad CSA LSI. Involved limb PT CSA mattered more in predicting peak knee extensor torque than did Quad CSA, but in the uninvolved limb, Quad CSA was the most important predictor of peak knee extensor torque. Graft site patellar tendon hypertrophy is key for strong quadriceps early after ACLR. Early targeted loading via exercise to promote healing of the graft site patellar tendon may bring patients a step closer to winning their battle against quadriceps dysfunction.
LEVEL OF EVIDENCE
Level I.
目的
前交叉韧带重建后，股四头肌功能障碍普遍存在，尤其是使用骨-髌腱-骨（BPTB）自体移植物时。在移植物采集后髌腱（PT）肥大对伸膝力量的影响尚不清楚。本研究的目的是确定使用 BPTB 自体移植物进行 ACLR 后 1-2 个月时，PT 和股四头肌（Quad）横截面积（CSA）对伸膝力量的预测能力。
方法
这是对使用 BPTB 自体移植物进行 ACLR 后 1-2 个月的队列进行的横截面分析。收集了 13 名男性和 14 名女性的峰值伸膝扭矩以及使用超声成像测量的 PT 和 Quad CSA。简单线性回归比较了 QI 与 PT 和 Quad CSA 的肢体对称性指数（LSI）。对每条肢体进行逐步模型比较的多元线性回归，以预测峰值伸膝扭矩。基础模型包括人口统计学。在第一个模型中加入 Quad CSA，然后在第二个模型中加入 PT CSA。
结果
PT（p<0.001，R=0.693）和 Quad CSA LSI 均与 QI 呈正线性关系（p=0.013，R=0.223）。在受累肢体中，加入 PT CSA 可显著改善模型（R=0.781，ΔR=0.211，p<0.001）。在未受累肢体中，加入 Quad CSA 可改善模型，但加入 PT CSA 则不能。
结论
PT LSI 比 Quad CSA LSI 更能预测 QI。与 Quad CSA 相比，受累肢体的 PT CSA 对预测峰值伸膝扭矩更为重要，但在未受累肢体中，Quad CSA 是预测峰值伸膝扭矩的最重要指标。移植物部位髌腱肥大是 ACLR 后早期股四头肌强壮的关键。通过运动进行早期有针对性的加载以促进移植物部位髌腱愈合，可能使患者更接近战胜股四头肌功能障碍的目标。
证据水平
I 级。
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