Forelli Florian, Mazeas Jean, Korakakis Vasileios, Ramtoola Haashim, Vandebrouck Amaury, Duffiet Pascal, Ratte Louis, Kakavas Georgios, Bouzekaroui Alaoui Ismail, Douryang Maurice, Bjerregaard Andreas, Riera Jérôme, Rambaud Alexandre J M
Haute-Ecole Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland.
Orthopaedic Surgery Department, OrthoLab, Ramsay Healthcare, Clinic of Domont, Domont, France.
Sports Med Open. 2025 Apr 12;11(1):37. doi: 10.1186/s40798-025-00843-8.
After an anterior cruciate ligament reconstruction (ACLR), mounting evidence suggests that open kinetic chain (OKC) strengthening is safe, reduces the risk of anterior knee pain, and significantly improves the quadriceps strength. However, clinicians are reluctant to use OKC knee strengthening exercises mainly due to the strong beliefs that they might increase graft laxity. The objective of this scoping review is to identify the key criteria employed in the scientific literature for the safe introduction of OKC quadriceps strengthening following ACLR.
A scoping review of the literature was conducted on the online databases MEDLINE (PubMed), ScienceDirect, Embase and CINAHL Library online. Data regarding time-based criteria and/or clinical based criteria allowing OKC exercises introduction following ACLR were searched for. Only studies involving patients who performed quadriceps strengthening using any type of OKC exercises were included, regardless of the type, resistance location, load magnitude, type of muscle contraction, knee range of motion, or duration of the strengthening protocol.
Twenty-six studies met the inclusion criteria. Twenty-one employed time-based criteria for the introduction of OKC exercise. The median time from when OKC was permitted was 15 postoperative days (range 1-270 days), while the mean time was 31.6 ± 56.7 postoperative days. In 30.7% of the studies additional clinical examination components were used. These components included range of motion (0-100°), numeric pain scale score < 2 or 3, absence of joint effusion (assess by the stroke test), full knee active extension (assess by the straight leg raise), and walking without crutches for the decision-making regarding OKC exercise introduction.
Less than one study in 3 reported clinical criteria for the introduction of OKC exercise. This highlights the absence of consensus among surgeons and physiotherapists, thereby hindering their ability to make informed decisions based on scientific evidence. Although the use of OKC exercise appears to be safe, precautions to maintain the integrity of the surgical repair need to be implemented. The establishment of valid criteria is crucial to support evidence-based decision-making.
在前交叉韧带重建术（ACLR）后，越来越多的证据表明，开链运动（OKC）强化训练是安全的，可降低前膝疼痛风险，并显著提高股四头肌力量。然而，临床医生不太愿意使用OKC膝关节强化训练，主要是因为他们坚信这可能会增加移植物松弛度。本范围综述的目的是确定科学文献中用于在ACLR后安全引入OKC股四头肌强化训练的关键标准。
在在线数据库MEDLINE（PubMed）、ScienceDirect、Embase和CINAHL在线图书馆上对文献进行了范围综述。搜索了有关允许在ACLR后进行OKC训练的基于时间的标准和/或基于临床的标准的数据。仅纳入涉及使用任何类型的OKC训练进行股四头肌强化训练的患者的研究，无论训练类型、阻力位置、负荷大小、肌肉收缩类型、膝关节活动范围或强化训练方案的持续时间如何。
26项研究符合纳入标准。21项研究采用了基于时间的标准来引入OKC训练。允许进行OKC训练的中位时间为术后15天（范围1 - 270天），平均时间为术后31.6±56.7天。在30.7%的研究中使用了额外的临床检查指标。这些指标包括活动范围（0 - 100°）、数字疼痛量表评分<2或3、无关节积液（通过触诊试验评估）、膝关节完全主动伸展（通过直腿抬高评估）以及无需拐杖行走，以决定是否引入OKC训练。
每3项研究中不到1项报告了引入OKC训练的临床标准。这突出表明外科医生和物理治疗师之间缺乏共识，从而阻碍了他们基于科学证据做出明智决策的能力。尽管使用OKC训练似乎是安全的，但需要采取预防措施以维持手术修复的完整性。建立有效的标准对于支持循证决策至关重要。
