Lee Jin Hyuck, Lee Gyu Bin, Chung WooYong, Wang Ji Won, Han Sun Gyu, Rhim Hye Chang, Han Seung-Beom, Jang Ki-Mo
Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea.
Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA.
Diagnostics (Basel). 2024 Apr 23;14(9):871. doi: 10.3390/diagnostics14090871.
This study aimed to compare functional outcomes including knee muscle strength in the quadriceps and hamstrings, and proprioception, assessed through dynamic postural stability (overall stability index [OSI]) and self-reported outcomes in the operated and non-operated knees between anterior cruciate ligament reconstruction (ACLR) with meniscal repair for unstable (root and radial tears) and stable (longitudinal, horizontal, and bucket handle tears) meniscal tears. A total of 76 patients were randomly selected (41 with ACLR with meniscal repair for unstable meniscal tears and 35 with ACLR with meniscal repair for stable meniscal tears) at three different time points (preoperative, 6 months, and 12 months). Repeated measures analysis of variance was used to investigate the differences in outcomes for between-subject and within-subject factors. In the operated knees, there were no significant differences for functional outcomes between the two groups (all > 0.05). In the non-operated knees, a significant difference was observed for the OSI between the two groups, which was significantly higher in ACLR with meniscal repair for unstable meniscal tears than for stable meniscal tears at 6 months ( < 0.001). Multiple linear regression analysis showed that age ( = 0.027), preoperative OSI in the operated knees ( = 0.005), and postoperative OSI in the operated knees at 6 months ( = 0.002) were significant and independent predictors for OSI in the non-operated knees at 6 months postoperatively. Therefore, while no differences were observed in functional outcomes between the two groups in the operated knees, dynamic postural stability was poorer at 6 months postoperatively in the non-operated knees of patients with ACLR with meniscal repair for unstable meniscal tears. Furthermore, a significant correlation was observed between preoperative/postoperative dynamic postural stability in the operated knees and postoperative dynamic postural stability in the non-operated knees. Hence, we recommend incorporating balance exercises for both knees in post-surgical rehabilitation, particularly for patients with unstable meniscal tears.
本研究旨在比较功能结局，包括股四头肌和腘绳肌的膝关节肌肉力量以及本体感觉，通过动态姿势稳定性（总体稳定性指数[OSI]）进行评估，并比较前交叉韧带重建（ACLR）联合半月板修复治疗不稳定（根部和放射状撕裂）和稳定（纵向、水平和桶柄状撕裂）半月板撕裂的手术膝关节与非手术膝关节的自我报告结局。在三个不同时间点（术前、6个月和12个月）共随机选取了76例患者（41例为ACLR联合半月板修复治疗不稳定半月板撕裂，35例为ACLR联合半月板修复治疗稳定半月板撕裂）。采用重复测量方差分析来研究组间和组内因素在结局方面的差异。在手术膝关节中，两组间功能结局无显著差异（均>0.05）。在非手术膝关节中，两组间OSI存在显著差异，在6个月时，ACLR联合半月板修复治疗不稳定半月板撕裂的患者的OSI显著高于治疗稳定半月板撕裂的患者（<0.001）。多元线性回归分析表明，年龄（=0.027）、手术膝关节术前OSI（=0.005）以及手术膝关节术后6个月的OSI（=0.002）是术后6个月非手术膝关节OSI的显著且独立预测因素。因此，虽然手术膝关节两组间功能结局无差异，但ACLR联合半月板修复治疗不稳定半月板撕裂患者的非手术膝关节在术后6个月时动态姿势稳定性较差。此外，手术膝关节术前/术后动态姿势稳定性与非手术膝关节术后动态姿势稳定性之间存在显著相关性。因此，我们建议在术后康复中对双膝关节进行平衡训练，尤其是对于不稳定半月板撕裂的患者。
