Stanish W D, Lai A
Dalhousie University, Halifax, Nova Scotia, Canada.
Clin Sports Med. 1993 Jan;12(1):25-58.
Can a knee joint with a torn ACL of 2 years' duration ever be able to return to high performance? Very unlikely indeed. Some realistic expectations follow: 1. The knee joint can never be normal after an ACL reconstruction. 2. Surgery must take place as early after the injury as possible, before secondary joint degeneration takes place. 3. The surgery must employ a tissue that best matches the normal ACL in strength and structure. 4. The surgery must involve as little trauma as possible while restoring knee joint mechanics. 5. Stress, although guarded, must be faced by the knee joint as soon as possible after surgery. 6. Progressive weight bearing starts immediately, combined with quadriceps isometrics. ROM of the knee joint, particularly full extension, is conserved and protected. 7. Progressive active ROM without formal resistance continues for 4 weeks. 8. Progressive formal resistance exercises continue for at least 1 year. 9. Sport-specific tasks commence at 16 weeks, depending on the requirement of the sport and the response of the individual athlete. 10. Recovery will plateau at several stages, with the final plateau at approximately 18 months. Knee instability is an exciting but perplexing problem. Although we have advanced profoundly from the era of Jones, Smiley, and others, we still face many of the same challenges as our predecessors. New technology should not fool us. We are still addressing a major structural failure within the knee joint. Our attempts have been non-surgical and surgical, with repair, reconstruction, and replacement. However, fundamental to all of these hopes has been the reconditioning of the extremity after ACL surgery. Can we do better than our forefathers like Licht and others? No one is certain. This article offers an approach, in some areas our approach, but should not be perceived as a cookbook. Individual responses by our patients, athletes, dictate whether any protocol is too hasty or tardy. It is fundamental that we listen to our patients objectively and analyze the knee as it returns from the surgical aggression. The ultimate success of the rehabilitation process will be based on the marriage of science and realistic expectations.
一个前交叉韧带撕裂达2年之久的膝关节还能恢复到高水平运动状态吗？确实极不可能。以下是一些现实的期望：1. 前交叉韧带重建术后膝关节永远无法恢复正常。2. 手术必须在损伤后尽早进行，在继发性关节退变发生之前。3. 手术必须使用在强度和结构上与正常前交叉韧带最匹配的组织。4. 手术在恢复膝关节力学的同时必须尽可能减少创伤。5. 术后膝关节尽管要谨慎对待，但必须尽快承受压力。6. 立即开始渐进性负重，并结合股四头肌等长收缩练习。膝关节的活动范围，尤其是完全伸直，要加以保留和保护。7. 进行4周无正式阻力的渐进性主动活动范围练习。8. 进行至少1年的渐进性正式抗阻练习。9. 根据运动项目的要求和个体运动员的反应，在16周时开始进行特定运动任务。10. 恢复在几个阶段会趋于平稳，最终平稳期约在18个月时。膝关节不稳定是一个令人关注但又令人困惑的问题。尽管我们已从琼斯、斯迈利等人的时代取得了巨大进步，但我们仍面临着许多与前辈相同的挑战。新技术不应使我们盲目。我们仍在应对膝关节内的重大结构损伤问题。我们尝试了非手术和手术方法，包括修复、重建和置换。然而，所有这些希望的根本在于前交叉韧带手术后肢体的康复。我们能比利希特等前辈做得更好吗？没人能确定。本文提供了一种方法，在某些方面是我们的方法，但不应被视为一本操作手册。我们的患者、运动员的个体反应决定了任何方案是过于仓促还是迟缓。至关重要的是，我们要客观地倾听患者的意见，并在膝关节从手术创伤中恢复时对其进行分析。康复过程的最终成功将基于科学与现实期望的结合。
