同时进行半月板切除术或半月板修复术会影响前交叉韧带重建术后的肌肉力量、下肢平衡和功能测试吗?

Does Concomitant Meniscectomy or Meniscus Repair Affect Muscle Strength, Lower Extremity Balance, and Functional Tests after Anterior Cruciate Ligament Reconstruction?

作者信息

Biały Maciej, Kublin Kamil, Wilczyński Bartosz, Forelli Florian, Gnat Rafał

机构信息

Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland.

Functional Diagnostics Laboratory, Sport-Klinika, Scanmed Sport, 44-240 Żory, Poland.

出版信息

J Clin Med. 2024 Jun 4;13(11):3310. doi: 10.3390/jcm13113310.

Abstract

: The effects of concomitant meniscal tears and their associated treatment on strength, lower extremity balance, and functional status after anterior cruciate ligament reconstruction (ACLR) have not been widely investigated. This study aimed to compare the functional outcomes in patients who underwent ACLR with concomitant treatment of the medial meniscus repair versus meniscectomy when returning to unrestricted physical activity. : A total of 85 patients who underwent primary ACLR with combined meniscal repair (MREP; = 39) or meniscectomy (MRES; = 46) were assessed. The dataset included the Functional Movement Screen (FMS) outcomes and single-leg balance test (SLBT) with anterior-posterior, medial-lateral, and overall stability indexes. Isokinetic knee extension and flexion strengths were tested at velocities of 60 deg·s and 180 deg·s. The peak torque-to-body weight ratio (PT/BW) and limb symmetry index (LSI) were calculated. : In the functional assessment, there was no significant inter-group difference in the composite score of the FMS (MREP: 15.08 pts vs. MRES: 15.13 pts; > 0.05). The SLBT outcomes in inter-group and inter-extremity comparisons were irrelevant ( > 0.05), too. Significant differences emerged in the inter-group comparison of the knee extension strength in the non-operated extremity at both 60 deg·s and 180 deg·s ( = 0.02). Inter-extremity differences were significant in both the MREP and MRES groups for knee extension and flexion at both angular velocities (all values < 0.05). For knee extension, the LSI values ranged from 82% to 87%, and for flexion, from 77% to 84%, with no significant inter-group differences. : Patients undergoing ACLR with concomitant meniscal repair or resection did not exhibit differences in isokinetic muscle strength, lower extremity balance, and functional tests upon returning to activity. However, participants in both groups demonstrated significant differences between the operated and non-operated extremities as far as the knee joint extensor and flexor strengths are concerned. Therefore, rehabilitation protocols should prioritize equalizing inter-extremity strength differences after the ACLR with additional treatment procedures addressing the menisci.

摘要

前交叉韧带重建(ACLR)术后半月板撕裂及其相关治疗对力量、下肢平衡和功能状态的影响尚未得到广泛研究。本研究旨在比较接受ACLR并同时接受内侧半月板修复与半月板切除术治疗的患者在恢复无限制体育活动时的功能结局。

共评估了85例接受初次ACLR并联合半月板修复(MREP;n = 39)或半月板切除术(MRES;n = 46)的患者。数据集包括功能性运动筛查(FMS)结果和单腿平衡测试(SLBT)的前后、内外侧和整体稳定性指标。在60°·s和180°·s的速度下测试等速膝关节伸展和屈曲力量。计算峰值扭矩与体重比(PT/BW)和肢体对称指数(LSI)。

在功能评估中,FMS综合评分在组间无显著差异(MREP:15.08分 vs. MRES:15.13分;P > 0.05)。组间和肢体间比较的SLBT结果也无相关性(P > 0.05)。在非手术侧膝关节伸展力量的组间比较中,在60°·s和180°·s时均出现显著差异(P = 0.02)。在MREP组和MRES组中,在两个角速度下膝关节伸展和屈曲的肢体间差异均显著(所有P值 < 0.05)。对于膝关节伸展,LSI值范围为82%至87%,对于屈曲,范围为77%至84%,组间无显著差异。

接受ACLR并同时进行半月板修复或切除的患者在恢复活动时,等速肌力、下肢平衡和功能测试方面未表现出差异。然而,就膝关节伸肌和屈肌力量而言,两组参与者的手术侧和非手术侧之间均表现出显著差异。因此,康复方案应优先考虑在ACLR后均衡肢体间力量差异,并采用额外的治疗程序处理半月板问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca69/11172927/e3059935f148/jcm-13-03310-g001.jpg

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