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前交叉韧带重建术后股四头肌与腘绳肌腱自体移植的晚期康复效果无差异:一项多中心倾向评分匹配的病例对照干预试验。

Late-stage rehabilitation effects do not differ between quadriceps and hamstring tendon autograft after anterior cruciate ligament reconstruction: a multicentre propensity score-matched case-control intervention trial.

作者信息

Niederer Daniel, Keller Matthias, Petersen Wolf, Mengis Natalie, Eberle Christian, Guenther Daniel, Brandl Georg, Drews Björn H, Engeroff Tobias, Vogt Lutz, Groneberg David A, Stein Thomas

机构信息

Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt.

Department of Movement and Training Science, Faculty of Humanities and Social Sciences, Institute of Sport Science, University of Wuppertal, Wuppertal, Germany.

出版信息

Biol Sport. 2025 Apr;42(2):135-149. doi: 10.5114/biolsport.2025.142647. Epub 2024 Oct 15.


DOI:10.5114/biolsport.2025.142647
PMID:40182721
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11963125/
Abstract

Late-stage rehabilitation interventions after an anterior cruciate ligament (ACL) reconstruction are under-researched, inter alia regarding potential differences in rehabilitation effects between autograft types. This study determined the effectiveness of a specific, late-stage rehabilitation to usual care after ACL reconstructions in patients with a quadriceps versus such with a hamstring tendon autograft. In this multicentre case-control intervention study, participants aged 18-35 years were included at the end of their formal rehabilitation (mean 8.1 months) after ACL reconstruction. Twenty-four cases with an arthroscopically assisted, anatomic ipsilateral quadriceps femoris tendon autograft and two numerically equal hamstring tendon reconstructed propensity score-matched groups were compared. Matching variables were gender, age, Tegner activity scale, plus, once, the time since reconstruction and once the functional capacity at intervention onset. All participants performed a 5-month performance enhancing intervention. All outcomes were measured once a month. Self-reported outcomes such as knee function (The Knee injury and Osteoarthritis Outcome Score (KOOS) Sport as the main self-reported outcome) were followed by a series of hop and jump tests. The front hops for distance (outcome: hopping distance) was the primary outcomes of the study. Linear mixed models were calculated using change scores. All participants were analysed. No group*time interaction effect could be identified in the two main outcomes KOOS SPORT and front hop for distance. Furthermore, with the exception of the self-reported all-day function, no outcome displayed any between-group differences in the trainability, either. The return-to-sport success took a mean time of 3.8 months after study commencement; the success rates ranged between 80% and 83% and were not different between groups. Being reconstructed with a hamstrings or with a quadriceps tendon autograft had no impact on the late-stage rehabilitation effects after an ACL rupture. Both graft choices enable comparably favourable functional outcomes and return-to-sport success rates. Conversely, no recommendation can be derived with regard to the selection of either a hamstring or a quadriceps autograft type. The decision must be undertaken individually and based on other factors.

摘要

前交叉韧带(ACL)重建术后的晚期康复干预研究不足,尤其是关于不同自体移植物类型在康复效果上的潜在差异。本研究确定了一种特定的晚期康复方案对比ACL重建术后常规护理对股四头肌自体移植物与腘绳肌腱自体移植物患者的有效性。在这项多中心病例对照干预研究中,18 - 35岁的参与者在ACL重建术后正式康复结束时(平均8.1个月)被纳入。比较了24例接受关节镜辅助下解剖学同侧股四头肌肌腱自体移植物的病例以及两个数量相等的、倾向评分匹配的腘绳肌腱重建组。匹配变量包括性别、年龄、Tegner活动量表,另外还包括重建后的时间以及干预开始时的功能能力各一次。所有参与者都进行了为期5个月的性能提升干预。所有结果每月测量一次。自我报告的结果,如膝关节功能(以膝关节损伤和骨关节炎结局评分(KOOS)运动作为主要自我报告结果)之后是一系列单脚跳和跳跃测试。向前单脚跳远距离(结果:单脚跳距离)是该研究的主要结果。使用变化分数计算线性混合模型。对所有参与者进行了分析。在两个主要结果KOOS SPORT和向前单脚跳远距离中未发现组*时间交互效应。此外,除了自我报告的全天功能外,在可训练性方面也没有任何结果显示出组间差异。恢复运动成功的平均时间为研究开始后3.8个月;成功率在80%至83%之间,且组间无差异。用腘绳肌腱或股四头肌肌腱自体移植物重建对ACL断裂后的晚期康复效果没有影响。两种移植物选择都能带来相当良好的功能结果和恢复运动成功率。相反,关于选择腘绳肌或股四头肌自体移植物类型无法得出推荐意见。必须根据个体情况并基于其他因素做出决定。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/e42235438b66/JBS-42-54708-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/12a87dafdf72/JBS-42-54708-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/33dc17dd9767/JBS-42-54708-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/094dcb3b8664/JBS-42-54708-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/37ef2cff804e/JBS-42-54708-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/e42235438b66/JBS-42-54708-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/12a87dafdf72/JBS-42-54708-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/33dc17dd9767/JBS-42-54708-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/08d17f2524cd/JBS-42-54708-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/094dcb3b8664/JBS-42-54708-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/37ef2cff804e/JBS-42-54708-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/406f/11963125/e42235438b66/JBS-42-54708-g006.jpg

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本文引用的文献

[1]
Late-stage rehabilitation after anterior cruciate ligament reconstruction: A multicentre randomised controlled trial (PReP).

Ann Phys Rehabil Med. 2024-5

[2]
Management after acute injury of the anterior cruciate ligament (ACL). Part 3: Recommendation on surgical treatment.

Knee Surg Sports Traumatol Arthrosc. 2024-2

[3]
Quadriceps and hamstring anterior cruciate ligament reconstruction differ only marginally in function after the rehabilitation: a propensity score-matched case-control study.

Knee Surg Sports Traumatol Arthrosc. 2023-8

[4]
Functional outcomes after anterior cruciate ligament reconstruction: unravelling the role of time between injury and surgery, time since reconstruction, age, gender, pain, graft type, and concomitant injuries.

BMC Sports Sci Med Rehabil. 2023-4-1

[5]
Contributors to self-report motor function after anterior cruciate ligament reconstruction.

Sci Rep. 2023-2-22

[6]
Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction.

Br J Sports Med. 2023-5

[7]
Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus.

Br J Sports Med. 2022-12

[8]
Acute effects of a neuromuscular warm-up on potential re-injury risk factors associated with unanticipated jump landings after anterior cruciate ligament reconstruction: A crossover trial.

Phys Ther Sport. 2021-11

[9]
Quadriceps Tendon Autograft Versus Bone-Patellar Tendon-Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Am J Sports Med. 2022-10

[10]
Quadriceps Tendon Versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Am J Sports Med. 2022-12

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