Brinkman Joseph C, Iturregui Jose M, Moore M Lane, Haglin Jack, Thompson Adam, Makovicka Justin, Economopoulos Kostas J
Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A.
Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Feb 22;6(3):100914. doi: 10.1016/j.asmr.2024.100914. eCollection 2024 Jun.
To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction.
A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications.
Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years' follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant ( < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively ( < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension.
For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. In addition, subjects demonstrated a high rate of return to sport and return to preinjury performance levels.
Level IV, therapeutic case series.
评估关节镜下后关节囊松解术对前交叉韧带（ACL）重建术后运动员终末伸展丧失的治疗效果。
对2014年1月至2019年12月期间因ACL重建术后膝关节伸展丧失而接受关节镜下后关节囊松解术的患者进行回顾性分析，这些数据是前瞻性收集的。手术指征包括ACL重建术后至少3个月出现大于10°的伸展丧失且物理治疗无效。纳入标准为参与高中或大学体育运动、有完整的相关结局数据且随访至少2年的患者。前瞻性收集的结局指标包括术前和术后膝关节伸展度测量、国际膝关节文献委员会（IKDC）评分、Lysholm评分、恢复运动数据及并发症情况。
分析纳入了18名接受单一位外科医生进行ACL重建术后后关节囊松解术且随访至少2年的运动员。患者平均在ACL重建术后16周接受手术。随访2年时膝关节伸展平均改善13.8°（松解术前平均伸展缺失15.1°，松解术后平均伸展缺失1.3°，P<0.005）。IKDC评分在6个月时平均改善21.7分，24个月时平均改善35.0分，差异均有统计学意义（P<0.001）。同样，Lysholm评分在6个月和2年时分别显著改善23.0分和34.2分（P<0.001）。总共77.8%的患者在初次ACL手术后平均9.8个月、后关节囊松解术后平均6.5个月恢复运动。未观察到感染或神经血管并发症。1例患者需要二次松解以获得足够的伸展度。
对于ACL重建术后持续存在膝关节伸展丧失的运动员，关节镜下后关节囊松解术后2年膝关节伸展度有显著改善。患者报告的结局指标也有显著改善。此外，受试者恢复运动的比例较高，且恢复到了伤前的运动水平。
IV级，治疗性病例系列。
