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多韧带膝关节重建术后的手术时机与康复

Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction.

作者信息

Herman Zachary J, Kaarre Janina, Wackerle Anja M, Lott Ariana, Apseloff Nicholas A, Lesniak Bryson P, Irrgang James J, Musahl Volker

机构信息

UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, Pittsburgh, USA.

Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

出版信息

Curr Rev Musculoskelet Med. 2024 Nov;17(11):476-483. doi: 10.1007/s12178-024-09923-w. Epub 2024 Aug 23.

Abstract

PURPOSE OF REVIEW

To provide an overview of the current evidence of the timing of surgery and rehabilitation after multiligamentous knee injuries (MLKIs) and offer insights into the ongoing multi-center randomized controlled study, the 'STaR trial'.

RECENT FINDINGS

Due to the complexity of the MKLIs, they are usually treated surgically with the goal of either repairing or reconstructing the injured ligaments. Although the current literature on MLKIs is relatively extensive, the consensus on the timing of surgery or rehabilitation following surgery for MLKIs is still lacking. While current literature mostly suggests early treatment, there is also evidence preferring delayed treatment. Furthermore, evidence on the timing of postoperative rehabilitation is limited. Thus, the current multi-center randomized controlled study, the 'STaR trial', is expected to respond to these questions by adding new high-level evidence. The MLKIs are often associated with knee dislocation and constitute a highly complex entity, including concomitant injuries, such as neurovascular, meniscal, and cartilaginous injuries. The treatment of MLKIs usually aims to either repair or reconstruct the injured ligaments, however, there is no general consensus on the timing of surgery or rehabilitation following an MLKI surgery. This current review stresses the need for more high-level research to address the paucity of evidence-based treatment guidelines for the treatment of complex MLKIs.

摘要

综述目的

概述目前多韧带膝关节损伤(MLKIs)后手术时机和康复的现有证据,并深入探讨正在进行的多中心随机对照研究“STaR试验”。

最新发现

由于MLKIs的复杂性,通常采用手术治疗,目的是修复或重建受损韧带。虽然目前关于MLKIs的文献较为广泛,但对于MLKIs手术后的手术时机或康复时机仍缺乏共识。虽然目前的文献大多建议早期治疗,但也有证据支持延迟治疗。此外,关于术后康复时机的证据有限。因此,目前的多中心随机对照研究“STaR试验”有望通过增加新的高级别证据来回答这些问题。MLKIs常与膝关节脱位相关,是一个高度复杂的情况,包括伴随的损伤,如神经血管、半月板和软骨损伤。MLKIs的治疗通常旨在修复或重建受损韧带,然而,对于MLKI手术后的手术时机或康复时机尚无普遍共识。本综述强调需要更多的高级别研究,以解决复杂MLKIs治疗中缺乏循证治疗指南的问题。

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本文引用的文献

1
Long-term Outcomes After Surgical Reconstruction of Multiligamentous Knee Injuries: Results at Minimum 10-Year Follow-up.
Orthop J Sports Med. 2024 Jan 12;12(1):23259671231223188. doi: 10.1177/23259671231223188. eCollection 2024 Jan.
2
Higher success rate observed in reconstruction techniques of acute posterolateral corner knee injuries as compared to repair: an updated systematic review.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5565-5578. doi: 10.1007/s00167-023-07582-x. Epub 2023 Oct 17.
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Diagnosis and treatment strategies of the multiligament injured knee: a scoping review.
Br J Sports Med. 2023 May;57(9):543-550. doi: 10.1136/bjsports-2022-106425. Epub 2023 Feb 23.
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J Am Acad Orthop Surg. 2023 Feb 15;31(4):e198-e206. doi: 10.5435/JAAOS-D-22-00339. Epub 2022 Nov 9.
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Incidence of Associated Lesions of Multiligament Knee Injuries: A Systematic Review and Meta-analysis.
Orthop J Sports Med. 2021 Jun 23;9(6):23259671211010409. doi: 10.1177/23259671211010409. eCollection 2021 Jun.
10
Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury.
Orthop J Sports Med. 2021 Mar 29;9(3):2325967121994203. doi: 10.1177/2325967121994203. eCollection 2021 Mar.

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