Weaver Adam P, Harkey Matthew S, Pacicca Donna M, Crepeau Allison E, Brown Matthew J, Werner Brian C, Diduch David R, Kuenze Christopher
Connecticut Children's Sports Physical Therapy, Farmington, Connecticut, USA.
Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.
Orthop J Sports Med. 2025 Jan 24;13(1):23259671241305999. doi: 10.1177/23259671241305999. eCollection 2025 Jan.
There has been increased interest in lateral extra-articular procedures, such as anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET), to reduce anterolateral rotation instability of the knee after anterior cruciate ligament reconstruction (ACLR). Despite promising surgical outcomes with these techniques, their impact on knee strength recovery is unknown.
Patients undergoing lateral extra-articular procedures at the time of ACLR would have impaired thigh muscle strength at 6 to 9 months after surgery.
Cohort study; Level of evidence, 3.
Adolescent patients who had undergone primary unilateral ACLR with lateral extra-articular augmentation between 2017 and 2023 were identified. Patients were included if they were aged between 12 and 20 years at the time of surgery and had completed an isokinetic strength assessment at 6 to 9 months after surgery. A total of 104 participants (mean age, 16.5 ± 1.7 years; 63 female) were included in this analysis: 25 who underwent ACLR+ALLR, 17 who underwent ACLR+LET, and 62 who underwent isolated ACLR. Isokinetic knee extension and flexion strength normalized to body weight, as well as the bilateral limb symmetry index (LSI), were assessed. One-way analysis of variance and analysis of covariance were used to compare differences between surgical techniques.
After adjusting for age, graft type, and time since surgery, the ACLR+LET (1.36 ± 0.52 N·m/kg) and ACLR+ALLR (1.61 ± 0.53 N·m/kg) groups had significantly less involved limb knee extension strength ( = .025), uninvolved limb knee extension strength ( = .046), and LSI for knee extension strength ( = .040) compared to the isolated ACLR group. There were no differences between the 3 groups regarding involved limb knee flexion strength ( = .222) or uninvolved limb knee flexion strength ( = .984), but the isolated ACLR group displayed a greater LSI for knee flexion strength (96.6% ± 17.8%; = .012).
The addition of lateral extra-articular procedures at the time of ACLR was associated with decreased quadriceps strength at 6 to 9 months after ACLR. While lateral extra-articular procedures may enhance knee rotary stability after ACLR, prolonged rehabilitation may be needed to re-establish adequate quadriceps strength before return to sports.
人们对外侧关节外手术越来越感兴趣，如前外侧韧带重建（ALLR）或外侧关节外肌腱固定术（LET），以减少前交叉韧带重建（ACLR）后膝关节的前外侧旋转不稳定。尽管这些技术取得了令人满意的手术效果，但其对膝关节力量恢复的影响尚不清楚。
在ACLR时接受外侧关节外手术的患者在术后6至9个月时大腿肌肉力量会受损。
队列研究；证据等级，3级。
确定2017年至2023年间接受初次单侧ACLR并进行外侧关节外增强手术的青少年患者。纳入标准为手术时年龄在12至20岁之间且在术后6至9个月完成了等速力量评估的患者。本分析共纳入104名参与者（平均年龄，16.5±1.7岁；63名女性）：25名接受ACLR+ALLR，17名接受ACLR+LET，62名接受单纯ACLR。评估了等速膝关节伸展和屈曲力量与体重的比值，以及双侧肢体对称指数（LSI）。采用单因素方差分析和协方差分析比较手术技术之间的差异。
在调整年龄、移植物类型和术后时间后，与单纯ACLR组相比，ACLR+LET组（1.36±0.52N·m/kg）和ACLR+ALLR组（1.61±0.53N·m/kg）患侧肢体膝关节伸展力量（P=.025）、健侧肢体膝关节伸展力量（P=.046）以及膝关节伸展力量的LSI（P=.040）均显著降低。三组之间患侧肢体膝关节屈曲力量（P=.222）或健侧肢体膝关节屈曲力量（P=.984）无差异，但单纯ACLR组膝关节屈曲力量的LSI更高（96.6%±17.8%；P=.012）。
ACLR时增加外侧关节外手术与ACLR术后6至9个月时股四头肌力量下降有关。虽然外侧关节外手术可能会增强ACLR后膝关节的旋转稳定性，但在恢复运动前可能需要延长康复时间以重新建立足够的股四头肌力量。
