Rosenberg Ashley M, Stern Brocha Z, Tiao Justin, Hoang Timothy, Zaidat Bashar, Darden Christon N, Gladstone James N, Anthony Shawn G
Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Arthroscopy. 2024 Dec 11. doi: 10.1016/j.arthro.2024.12.004.
To identify whether the timing of supervised physical rehabilitation initiation after isolated arthroscopic anterior cruciate ligament reconstruction (ACLR) is associated with (1) diagnosis of arthrofibrosis and (2) surgical intervention for arthrofibrosis within 12 months after surgery.
Outpatient isolated arthroscopic ACLR procedures in 2017-2020 were identified from the Merative MarketScan database. The cohort was limited to patients aged 18 to 64 years who initiated supervised physical rehabilitation at 0 to 30 days postoperatively and had continuous enrollment in the database for 12 months before and after surgery. Multivariable logistic regression models analyzed the adjusted relationship between rehabilitation initiation timing (categorized as 0-3, 4-7, 8-14, and 15-30 days) and arthrofibrosis outcomes; P < .05 was considered statistically significant.
The cohort included 13,273 patients (33.7% of whom initiated rehabilitation 0-3 days after surgery; 27.1%, 4-7 days; 22.5%, 8-14 days; and 16.7%, 15-30 days). The incidence of 12-month arthrofibrosis diagnosis was 11.6%, and the incidence of 12-month surgical intervention for arthrofibrosis was 1.6%. There were no significant adjusted associations between the earliest timing (0-3 days) and latest timing (15-30 days) of initiating supervised rehabilitation and 12-month arthrofibrosis diagnosis (odds ratio, 1.15; 95% confidence interval, 0.97-1.36; P = .10) or surgical intervention (odds ratio, 0.81; 95% confidence interval, 0.53-1.22; P = .31). There were also no significant adjusted associations between any other timing of initiating supervised rehabilitation (compared with 15-30 days) and arthrofibrosis diagnosis or surgical intervention (P > .05 for all).
Approximately 1 in 10 patients undergoing isolated arthroscopic ACLR and initiating supervised rehabilitation within 30 days after surgery received a diagnosis of arthrofibrosis within 12 months, indicating that this complication is quite common. The number of patients receiving surgical intervention for arthrofibrosis was much lower. Timing of supervised physical rehabilitation initiation within the first 30 days after surgery was not significantly associated with the incidence of 12-month arthrofibrosis diagnosis or surgical intervention.
Level III, therapeutic, retrospective comparative study.
确定单纯关节镜下前交叉韧带重建术（ACLR）后开始有监督的物理康复训练的时机是否与（1）关节纤维化的诊断以及（2）术后12个月内针对关节纤维化的手术干预相关。
从Merative MarketScan数据库中识别出2017 - 2020年门诊进行的单纯关节镜下ACLR手术。该队列仅限于年龄在18至64岁之间、术后0至30天开始有监督的物理康复训练且在手术前后连续纳入数据库12个月的患者。多变量逻辑回归模型分析了康复训练开始时机（分为0 - 3天、4 - 7天、8 - 14天和15 - 30天）与关节纤维化结局之间的校正关系；P < 0.05被认为具有统计学意义。
该队列包括13273例患者（其中33.7%在术后0 - 3天开始康复训练；27.1%在4 - 7天；22.5%在8 - 14天；16.7%在15 - 30天）。12个月时关节纤维化的诊断发生率为11.6%，12个月时针对关节纤维化的手术干预发生率为1.6%。开始有监督康复训练的最早时机（0 - 3天）和最晚时机（1)5 - 30天）与12个月时关节纤维化的诊断（优势比，1.15；95%置信区间，0.97 - 1.36；P = 0.10）或手术干预（优势比，0.81；95%置信区间，0.53 - 1.22；P = 0.31）之间均无显著的校正关联。开始有监督康复训练的任何其他时机（与15 - 30天相比）与关节纤维化的诊断或手术干预之间也无显著的校正关联（所有P > 0.）。
在接受单纯关节镜下ACLR且术后30天内开始有监督康复训练的患者中，约十分之一在12个月内被诊断为关节纤维化，表明这种并发症相当常见。接受关节纤维化手术干预的患者数量要低得多。术后前30天内开始有监督物理康复训练的时机与12个月时关节纤维化的诊断发生率或手术干预之间无显著关联。
III级，治疗性，回顾性比较研究。
