Lin Yu-Yang, Christiansen Blaine A
Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, University of California Davis Health, Sacramento, CA, USA.
Connect Tissue Res. 2025 May 23:1-7. doi: 10.1080/03008207.2025.2507858.
Injury of the anterior cruciate ligament (ACL) is a common sports injury that can lead to post-traumatic osteoarthritis (PTOA) within 10-20 years. Surgical ACL reconstruction is often performed several weeks or months after injury, and this period between injury and ACL reconstruction may be a critical time for determining the risk of long-term PTOA progression. However, few (if any) studies in human patients have investigated the long-term effects of exercise or unloading between ACL injury and surgery. Early mobilization is often recommended to maintain range of motion and muscle strength, which are beneficial for positive outcomes of ACL reconstruction, but it is unknown what effects early mobilization or unloading have on long-term PTOA progression. In preclinical animal studies, a brief period of joint unloading immediately after ACL injury significantly decreased osteophyte formation and articular cartilage degeneration, while longer-term non-weightbearing caused muscle atrophy and articular cartilage degradation. Similarly, preclinical studies have shown that different intensities of exercise after knee injury can have divergent effects on PTOA development. Low intensity exercise was protective against joint degeneration, while higher intensity exercise accelerated PTOA progression. The beneficial or detrimental effects of exercise and unloading following ACL injury are likely dependent on the timing, duration, and intensity of these biomechanical interventions. This review summarizes the effects of these biomechanical interventions after ACL injury in both humans and animal models, with the goal of informing therapeutic and rehabilitation strategies for slowing or preventing PTOA progression after injury.
前交叉韧带（ACL）损伤是一种常见的运动损伤，可在10 - 20年内导致创伤后骨关节炎（PTOA）。ACL重建手术通常在受伤数周或数月后进行，而从受伤到ACL重建的这段时间可能是确定长期PTOA进展风险的关键时期。然而，在人类患者中，很少有（如果有的话）研究调查ACL损伤与手术之间运动或负荷减轻的长期影响。早期活动通常被推荐用于维持关节活动范围和肌肉力量，这对ACL重建的良好结果有益，但早期活动或负荷减轻对长期PTOA进展有何影响尚不清楚。在临床前动物研究中，ACL损伤后立即进行短时间的关节负荷减轻可显著减少骨赘形成和关节软骨退变，而长期不负重会导致肌肉萎缩和关节软骨退化。同样，临床前研究表明，膝关节损伤后不同强度的运动对PTOA发展可能有不同影响。低强度运动对关节退变有保护作用，而高强度运动则加速PTOA进展。ACL损伤后运动和负荷减轻的有益或有害影响可能取决于这些生物力学干预的时间、持续时间和强度。本综述总结了ACL损伤后这些生物力学干预在人类和动物模型中的影响，目的是为减缓或预防损伤后PTOA进展的治疗和康复策略提供信息。
