Lindskog Jakob, Sundberg Axel, Högberg Johan, Hamrin Senorski Rebecca, Piussi Ramana, Samuelsson Kristian, Thomeé Roland, Hamrin Senorski Eric
Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
Sahlgrenska Sports Medicine Center, Sahlgrenska Academy Gothenburg Sweden.
J Exp Orthop. 2025 Jul 13;12(3):e70351. doi: 10.1002/jeo2.70351. eCollection 2025 Jul.
To compare patients with generalised joint hypermobility (GJH) who sustained a second anterior cruciate ligament (ACL) injury with those who did not sustain a second ACL injury, in terms of muscle strength, psychological response and level of knee-strenuous activity after primary ACL reconstruction. We hypothesised that patients who sustained a second ACL injury would display similar muscle strength symmetry, report similar psychological response and report greater levels of knee-strenuous activity compared to patients who did not sustain a second ACL injury.
Data from a rehabilitation specific registry were extracted. Patients 15-30 years old with GJH, who sustained a second ACL injury after primary ACL reconstruction were matched 1:2 with patients with GJH who did not sustain a second ACL injury. Outcomes were compared at the 10-week, 4-, 8- and 12-month follow-ups after primary ACL reconstruction. Outcomes comprised limb symmetry index and peak torque relative to body weight for quadriceps and hamstrings muscle groups assessed seated isokinetically with a Biodex. In addition, the questionnaires knee self-efficacy scale, ACL-return to sport after injury scale and Tegner activity scale (Tegner) were analysed. All outcome data were analysed with the independent -test, except for the Tegner which was analysed with the Mann-Whitney -test.
Thirty-two patients sustained a second ACL injury and were matched with 64 patients who did not. The mean age at time of ACL reconstruction was 19 ± 3 years, and 58 (60%) were female. There were no differences in muscle strength between groups at any follow-up. At the 8-month follow-up, patients with a second ACL injury reported higher on ACL-return to sport after Injury (65.6 ± 17.9 vs. 53.5 ± 17.3, = 0.006), and participated in gknee-strenuous activity (median Tegner 5.0, interquartile range [IQR]: 3.0 versus 4.0, IQR: 4.0, = 0.046) compared to patients without a second ACL injury.
Patients with GJH who sustained a second ACL injury reported greater confidence, lower negative emotions, and lesser risk appraisal towards return to sport, and reported greater levels of knee-strenuous activity at 8 months after primary ACL reconstruction compared to matched patients who did not sustain a second ACL injury. These findings might suggest that patients who report greater psychological readiness to RTS, that is, greater confidence, lower negative emotions and lesser risk appraisal, at 8 months, need more cautious guidance when increasing knee-strenuous activity.
Level IV, cross-sectional study.
比较初次前交叉韧带（ACL）重建术后发生第二次ACL损伤的广泛性关节活动过度（GJH）患者与未发生第二次ACL损伤的患者在肌肉力量、心理反应和膝关节剧烈活动水平方面的差异。我们假设，与未发生第二次ACL损伤的患者相比，发生第二次ACL损伤的患者将表现出相似的肌肉力量对称性，报告相似的心理反应，并报告更高水平的膝关节剧烈活动。
从一个康复专用登记处提取数据。将15 - 30岁、初次ACL重建术后发生第二次ACL损伤的GJH患者与未发生第二次ACL损伤的GJH患者按1:2进行匹配。在初次ACL重建术后10周、4个月、8个月和12个月的随访中比较结果。结果包括使用Biodex等速测定的股四头肌和腘绳肌组的肢体对称指数和相对于体重的峰值扭矩。此外，还分析了膝关节自我效能量表、ACL损伤后恢复运动量表和Tegner活动量表（Tegner）。除Tegner量表采用Mann-Whitney U检验分析外，所有结果数据均采用独立样本t检验进行分析。
32例患者发生了第二次ACL损伤，并与64例未发生第二次ACL损伤的患者进行了匹配。ACL重建时的平均年龄为19±3岁，58例（60%）为女性。在任何随访中，两组之间的肌肉力量均无差异。在8个月的随访中，与未发生第二次ACL损伤的患者相比，发生第二次ACL损伤的患者在ACL损伤后恢复运动量表上的得分更高（65.6±17.9对53.5±17.3，P = 0.006），并且参与膝关节剧烈活动（Tegner中位数5.0，四分位间距[IQR]：3.0对4.0，IQR：4.0，P = 0.046）。
与未发生第二次ACL损伤的匹配患者相比，初次ACL重建术后8个月时，发生第二次ACL损伤的GJH患者对恢复运动表现出更大的信心、更低的负面情绪和更低的风险评估，并且报告了更高水平的膝关节剧烈活动。这些发现可能表明，在8个月时报告对恢复运动有更大心理准备（即更大的信心、更低的负面情绪和更低的风险评估）的患者，在增加膝关节剧烈活动时需要更谨慎的指导。
IV级，横断面研究。
