自体材料重建前交叉韧带术后康复训练

目的:分析近年来关于自体材料重建前交叉韧带术后康复训练的文献资料,了解该领域的发展趋势。资料来源:通过计算机检索Medline1990-01/2005-03的文章,检索词为“anteriorcruciateligament,reconstruction,rehabilitation”,限定文章语言种类为English;另外检索中文期刊全文数据库2000-04/2005-04的文章,检索词为“前交叉韧带、重建术、康复”,文章语言为中文。资料选择:选取有关膝关节前交叉韧带重建术后康复训练的文章,纳入标准:①随机或自身前后对照的临床研究。②观点明确。③采用自体材料重建。排除标准:①综述。②重复性研究。③异体或异种材料重建。资料提炼:共检索到49篇关于膝关节前交叉韧带重建术后康复训练的文章,选择其中符合标准的25篇进行综述。资料综合:观察并比较保守、激进两种不同性质的康复训练方法对术后膝关节功能恢复的影响。一般来说,用骨-髌腱-骨重建后的康复训练应早于用腘绳肌重建,股四头肌肌力训练对术后膝关节功能恢复相当重要,闭链训练适用于康复早期,开链训练适用于康复晚期。由于前交叉韧带中存在着本体感受器,而重建材料中不含有本体感受器,故术后本体感觉促进训练对膝关节功能的完善至关重要。结论:前交叉韧带重建术后的康复训练变得越来越激进。康复训练方案应该按照重建材料的不同及个体差异分别制定。     

自体材料重建前交叉韧带术后康复训练

目的：分析近年来关于自体材料重建前交叉韧带术后康复训练的文献资料，了解该领域的发展趋势。 资料来源：通过计算机检索Medline1990-01／2005-03的文章，检索词为“anterior cruciate ligament，reconstruction，rehabilitation”，限定文章语言种类为English；另外检索中文期刊全文数据库2000-04／2005-04的文章，检索词为“前交叉韧带、重建术、康复”，文章语言为中文。 资料选择：选取有关膝关节前交叉韧带重建术后康复训练的文章，纳入标准：①随机或自身前后对照的临床研究。②观点明确。③采用自体材料重建。排除标准：①综述。②重复性研究。③异体或异种材料重建。 资料提炼：共检索到49篇关于膝关节前交叉韧带重建术后康复训练的文章，选择其中符合标准的25篇进行综述。 资料综合：观察并比较保守、激进两种不同性质的康复训练方法对术后膝关节功能恢复的影响。一般来说，用骨-髌腱-骨重建后的康复训练应早于用膪绳肌重建，股四头肌肌力训练对术后膝关节功能恢复相当重要，闭链训练适用于康复早期，开链训练适用于康复晚期。由于前交叉韧带中存在着本体感受器，而重建材料中不舍有本体感受器，故术后本体感觉促进训练对膝关节功能的完善至关重要。 结论：前交叉韧带重建术后的康复训练变得越来越激进。康复训练方案应该按照重建材料的不同及个体差异分别制定。     

Effect of lower limb dominance on knee joint kinematics after anterior cruciate ligament reconstruction

Background

Normal ambulatory kinematics of the knee joint is often not fully restored after anterior cruciate ligament reconstruction, which may increase the risk for cartilage degeneration and premature osteoarthritis in the involved knees. Lower limb dominance may have impacts on knee joint kinematics after anterior cruciate ligament reconstruction, which may lead to a different prevalence of cartilage degeneration. This study aimed to evaluate the knee joint kinematics among patients with reconstruction on the dominant and non-dominant side.

Methods

Forty-one subjects with unilateral anterior cruciate ligament reconstruction (19 dominant, 22 non-dominant) were recruited after being discharged from rehabilitation programs. Twenty healthy subjects were recruited as the control group. Six degrees-of-freedom tibiofemoral motion during level walking was determined using a redundant point cluster-based marker set. Tibiofemoral joint motion and its bilateral differences were compared within each group and between groups.

Findings

The non-dominant reconstructed knees had less extension compared to their contralateral knees at heel strike and during middle stance phase (P = 0.02); whereas, the dominant reconstructed knees exhibited significantly reduced varus rotation (− 2.1° on mean, P = 0.027) and internal tibial rotation (P = 0.034) compared to their contralateral knees during both stance and swing phases.

Interpretation

The results show that different kinematics has been developed between the involved dominant and non-dominant knees after anterior cruciate ligament reconstruction, especially the secondary rotations. The differences are consistent with the unequal prevalence of cartilage degeneration in the knee joint. The findings demonstrated that the lower limb dominance had a significant effect on post-surgery knee kinematics.     

Contralateral limb strength deficits after anterior cruciate ligament reconstruction using a hamstring tendon graft

BACKGROUND: The purpose of this study was to determine whether current post-operative rehabilitation protocols return the strength of the contralateral uninjured limb knee flexors and extensors after an anterior cruciate ligament (ACL) reconstruction to those of an uninjured control group. METHODS: Subjects with a hamstring tendon ACL reconstruction (n=12) were compared to an active control group (n=30). Comprehensive bilateral knee flexor and extensor isovelocity strength testing was performed (five speeds, 5-95 degrees , concentric and eccentric contractions). FINDINGS: After hamstring tendon ACL reconstruction and rehabilitation, bilateral strength normalization (within 10% of the contralateral limb) is achieved by the knee extensors but not the knee flexors. When compared to the uninjured control group, large and statistically significant strength deficits were demonstrated in the knee extensors and knee flexors of both the anterior cruciate ligament reconstructed (extensors 24.8%; flexors 26.8%) and the contralateral uninjured (extensors 21%; flexors 13.5%) limbs. INTERPRETATION: These findings suggest that improvement can be made in knee flexor rehabilitation after ACL reconstruction and limit the validity of the use of a contralateral leg as a rehabilitation endpoint or as a control in the ACL reconstructed population.     

Gait training using a hybrid assistive limb after botulinum toxin treatment for cerebral palsy: a case report

[Purpose] Hybrid Assistive Limb^® (HAL; Cyberdyne, Tsukuba, Japan) is a wearable robot that assists patients based on their voluntary movements. We report gait training with HAL after botulinum toxin treatment for spasticity of the lower limb in cerebral palsy (CP). [Participant and Methods] The participant was a 36 year-old male with spastic diplegia due to periventricular leukomalacia, with Gross Motor Function Classification System (GMFCS) level II. HAL training was performed in 20-minute sessions (3 sessions/week for 4 weeks). The outcome measures were range of motion, spasticity, walking ability, muscle strength, gross motor function measure (GMFM), Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory measured before, immediately after, and one, two, and three months after HAL training. [Results] No adverse events were observed during training. After the HAL intervention, gait speed, step length, cadence, 6-min walking distance (6MD), knee extension strength, GMFM, and COPM increased, and Physiological Cost Index declined. Three months post-intervention, gait speed, step length, cadence, 6MD, and GMFM remained higher than those observed within the first two months. [Conclusion] Gait training with HAL can be a safe and feasible method for patients with CP who undergo botulinum toxin treatment to improve walking ability and motor function.     

Effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction

[Purpose] This study examined the effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 16 adults who underwent arthroscopic anterior cruciate reconstruction and neuromuscular training. The Lysholm scale was used to assess functional disorders on the affected knee joint. A KT-2000 arthrometer was used to measure anterior displacement of the tibia against the femur. Surface electromyography was used to detect the muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus before and after neuromuscular training. [Results] There was significant relaxation in tibial anterior displacement of the affected and sound sides in the supine position before neuromuscular training. Furthermore, the difference in the tibial anterior displacement of the affected knee joints in the standing position was reduced after neuromuscular training. Moreover, the variation of the muscle activation evoked higher muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus. [Conclusion] Neuromuscular training may improve functional joint stability in patients with orthopedic musculoskeletal injuries in the postoperative period.Key words: Arthrometer, Anterior cruciate ligament reconstruction, Neuromuscular training     

平衡促进训练对膝关节前交叉韧带损伤重建术后患膝本体感觉的影响

目的:研究平衡促进训练对膝关节前交叉韧带(ACL)损伤重建术后患膝本体感觉的影响。方法:选取124例ACL损伤重建术后患者,全部进行常规康复训练12周,术后第12周采用随机数字法分成两组(对照组62例,训练组62例),训练组在第12周开始进行平衡促进训练,持续至第16周;对照组继续进行患肢肌力和步态训练,持续至第16周。采用专业平衡功能评定系统,分别在术后第12周和第16周对两组进行平衡功能测定。结果:术后第16周测定结果:①睁眼状态下,训练组与对照组在指标LFS指数和覆盖90%椭圆区域面积指数无显著差异(P>0.05)。②闭眼状态下,训练组与对照组在指标LFS指数和覆盖90%椭圆区域面积指数差异具有显著性意义(P<0.05)。结论:平衡促进训练对ACL损伤重建术后患者膝关节本体感觉能力恢复具有显著提高作用。     

Effect of a functional knee brace on knee flexion and extension strength after anterior cruciate ligament reconstruction

OBJECTIVES: To investigate the effect of a knee brace on knee flexion and extension muscular strength of patients after anterior cruciate ligament (ACL) reconstruction and to evaluate whether the effect of the brace depends on patient symptoms and muscular strength. DESIGN: Repeated measures. SETTING: A university-based outpatient orthopedic clinic and musculoskeletal assessment laboratory. PARTICIPANTS: Twenty-seven patients (14 women, 13 men; mean age, 28+/-11 y) having undergone arthroscopically assisted ACL reconstruction by using a semitendinosus and gracilis autograft. INTERVENTION: A custom-fit ACL functional knee brace. MAIN OUTCOME MEASURES: The brace effect was calculated as the change in peak torque observed with the brace, expressed as a percentage of peak torque observed without the brace, during isokinetic concentric knee flexion and extension movements performed at 90 degrees /s. Patient symptoms were quantified by using a disease-specific health-related quality of life questionnaire. RESULTS: Knee flexion strength decreased significantly with the brace (mean brace effect=-7.3%, P<.05). The brace effect during knee flexion varied considerably (-52% to 47%) and was significantly related to peak torque observed without the brace (r=-.50, P<.01). All other comparisons and correlations were not significant. CONCLUSIONS: These findings suggest that brace effects depend on patient strength. A brace may inhibit knee flexion strength of stronger patients, yet result in no change or even improvements in strength of weaker patients. Future research is required to further elucidate which patients may derive most benefit or detriment from bracing.     

全身振动训练对前交叉韧带损伤重建术后患者下肢运动控制的影响

目的:研究全身振动训练对膝关节前交叉韧带损伤(ACL)重建术后患者下肢肌力和运动控制的影响。方法:选取符合纳入标准的40例前交叉韧带损伤重建术后患者为研究对象,所有患者术后12周进行常规康复训练。第13周开始将患者用数字法随机分为对照组和试验组,每组20例。对照组继续给予常规康复训练,试验组在对照组的基础上,加入每天1次,每次10min,每周5次,持续4周的全身振动训练。两组患者第12周和第16周,均进行等速肌力测试训练系统膝关节屈伸肌群的峰力矩、拮抗肌比值检测和动态平衡仪中本体感觉评估。结果:1两组患者膝关节屈伸峰力矩,治疗前后和治疗后组间对比均有显著性差异(P0.05);2两组患者动态平衡测试的平均轨迹误差值,治疗前后和治疗后组间对比有显著性差异(P0.05)。结论:全身振动训练能够促进ACL重建术后患者的下肢肌力和运动控制的恢复。     

六股自体腘绳肌腱“人”字形编织重建膝关节前交叉韧带

背景：目前不同学者对膝关节损伤前交叉韧带重建方法存较多争论,因此寻找简便、经济的修复方法是目前该领域的研究热点。目的：观察关节镜下应用6股自体腘绳肌腱＂人＂字形编织重建修复前交叉韧带损伤的临床疗效。方法：对19例单侧前交叉韧带功能不全的患者采用6股自体腘绳肌腱人字形编织,胫骨隧道钻取双隧道模拟前内、后外两束重建膝关节前交叉韧带,于重建前后利用IKDC分级,Lysholm功能评分和KT-2000^TM关节动度仪测试试验,对患者进行主观和客观评分,并应用IKDC分级进行影像学评估。结果：19例患者随访的IKDC分级：A级8例、B级10例、C级1例,无伸膝受限,活动范围120°～140°,平均126°。KT-2000TM膝关节稳定性测量在90.7kg,136.1kg和最大拉力时,患膝和健膝之间的关节活动度差异均无显著性意义（P〉0.05）。随访时Lysholm膝关节功能评分显著高于重建前（P〈0.01）。影像学IKDC评估为：A级15例（79%）,B级3例（16%）,C级1例（5%）。结果证实,应用6股自体腘绳肌腱＂人＂字形编织双束重建前交叉韧带短期临床疗效良好。     

六股自体腘绳肌腱"人"字形编织重建膝关节前交叉韧带

背景:目前不同学者对膝关节损伤前交叉韧带重建方法存较多争论,因此寻找简便、经济的修复方法是目前该领域的研究热点.目的:观察关节镜下应用6股自体腘绳肌腱"人"字形编织重建修复前交叉韧带损伤的临床疗效.方法:对19例单侧前交叉韧带功能不全的患者采用6股自体腘绳肌腱人字形编织,胫骨隧道钻取双隧道模拟前内、后外两束重建膝关节前交叉韧带,于重建前后利用IKDC分级,Lysholm功能评分和KT-2000TM关节动度仪测试试验,对患者进行主观和客观评分,并应用IKDC分级进行影像学评估.结果:19例患者随访的IKDC分级:A级8例、B级10例、C级1例,无伸膝受限,活动范围120°~140°,平均126°.KT-2000TM膝关节稳定性测量在90.7 kg,136.1 kg和最大拉力时,患膝和健膝之间的关节活动度差异均无显著性意义 (P > 0.05).随访时Lysholm膝关节功能评分显著高于重建前(P < 0.01).影像学IKDC评估为:A级15例(79%),B级3例(16%),C级1例(5%).结果证实,应用6股自体腘绳肌腱"人"字形编织双束重建前交叉韧带短期临床疗效良好.     

Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction

[Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability.Key words: Anterior cruciate ligament, Preoperative exercise, Knee extensor strength     

Early rehabilitation after anterior cruciate ligament reconstruction under regional analgesia: a case report

Patients undergoing major knee surgery may experience postoperative pain, which could be exacerbated by early postoperative continuous passive motion or active mobilization. This pain may result in poor functional recovery. Use of regional analgesia techniques to achieve more consistent pain relief and to facilitate rapid rehabilitation can play an important role in optimizing postoperative outcome after anterior cruciate ligament repair (ACLR). This case study concerns a 20-year-old male soldier, otherwise healthy, who underwent ACLR. We inserted a catheter in the fascia iliaca compartment and performed postoperative analgesia with low-concentration ropivacaine by using an elastomeric pump. The patient started early rehabilitation under fascia iliaca compartment analgesia. We discuss the case and the influence of regional analgesia techniques on postoperative and clinical outcomes.     

中医治疗结合康复训练对关节镜下膝前交叉韧带重建术后早期膝关节功能的影响

目的:观察早期中医治疗结合康复训练对关节镜下膝前交叉韧带重建术后患者膝关节功能、疼痛程度、关节肿胀程度的影响,并与单纯康复训练效果进行比较。方法:①选择2003-02/2004-11四川省骨科医院膝关节科行关节镜下膝前交叉韧带重建术的住院患者32例,男19例,女13例。均签署知情同意书。采用随机单盲(患者盲)方法将患者分为2组:中医治疗 康复训练组和康复训练组,各16例。②中医治疗 康复训练组:于手术当天即进行活动足趾、踝关节,静力收缩股四头肌常规康复训练。康复训练一直持续至术后半年,强度随时间增加而加大。术后8h至术后7周在康复训练同时进行中医治疗:术后8h,2～4d内服膝伤1号方(黄连、黄芩、蒲公英、牛膝、郁金、酒军等),1剂/d,分3次口服。术后第2天同时行指针治疗,点揉足三里、阳陵泉、三阴交等穴,每穴15s,每次约10min。1次/d。术后第3天:中医外治法:指针治疗,选用足三里、阳陵泉、阴陵泉等穴,方法同前。电针治疗,选用足三里、阳陵泉、阴陵泉等穴交替使用,频率80次/min。术后第4天:中医外治法:指针治疗,选用足三里、阳陵泉、阴陵泉、三阴交、承山等穴,方法同前。电针治疗,方法与穴位同前。于术后第5～11天服用中药膝伤2号方(桃仁、当归、赤芍、川牛膝、木通、续断、白芨、香附、川黄连等)。1剂/d,分3次口服,连服7d,外治法:指针、电针治疗,穴位、方法同前。从术后第12天,开始服用中药膝伤3号方(黄芪、党参、地龙、木通、肉苁蓉、菟丝子、桑寄生、金毛狗脊、千年健、木瓜等),1剂/d,分3次口服。外治法:指针及电针治疗,方法同前。术后4～7周:中医内外治法:对症给予中药,配合指针点穴。术后8～12周:强化肌力训练。术后12周～6个月:恢复全部功能。康复训练组:常规术后康复训练同另组,不用中医方法治疗。③于术前,术后3,7,14,3个月采用目测类比评分进行量化评定休息和活动时疼痛程度,不痛为0,最痛为10.0。④于术后第3,4,17天行膝关节腔穿刺抽液观察关节肿胀程度。⑤于术前、术后7,14,3个月用骨关节量角器测量关节活动度。于术前、术后3个月采取询问方式应用Lysholm评分系统评估患者膝关节功能(总分0～100分,分数越高表示膝关节功能状况越好)。⑥于术前、术后3个月采用国际膝关节病例记载委员会-2000评分系统评估患者症状、膝关节功能、运动能力(采用分数积分法,以1代表最低水平的功能或最严重的症状。分数越高功能越好,症状越轻)。⑦计量资料差异比较采用t检验。结果:膝前交叉韧带重建术后患者32例均进入结果分析。①中医治疗 康复训练组患者术后3和7d休息痛和活动痛疼痛程度明显低于康复训练组(P<0.05),术后14d活动痛疼痛程度明显低于康复训练组(P<0.05)。②中医治疗 康复训练组患者术后7d和3个月关节活动度明显大于康复训练组(P<0.05)。③两组术后3,7,14d关节肿胀程度比较,差异不明显(P>0.05)。④两组术后3个月膝关节功能评分均明显高于术前(P<0.05),中医治疗 康复训练组术后3个月明显高于康复训练组(P<0.05)。⑤两组术前、术后3个月国际膝关节病例记载委员会-2000评分系统评分结果比较,差异不明显(P>0.05)。结论:早期中西医结合康复训练可减轻关节镜下膝前交叉韧带重建术后患者疼痛、膝关节肿胀程度,改善膝关节功能,作用效果优于单纯康复训练。     

中医治疗结合康复训练对关节镜下膝前交叉韧带重建术后早期膝关节功能的影响

目的：观察早期中医治疗结合康复训练对关节镜下膝前交叉韧带重建术后患者膝关节功能、疼痛程度、关节肿胀程度的影响，并与单纯康复训练效果进行比较。 方法：①选择2003—02／2004-11四川省骨科医院膝关节科行关节镜下膝前交叉韧带重建术的住院患者32例，男19例，女13例。均签署知情同意书。采用随机单盲（患者盲）方法将患者分为2组：中医治疗＋康复训练组和康复训练组，各16例。②中医治疗＋康复训练组：于手术当天即进行活动足趾、踝关节，静力收缩股四头肌常规康复训练。康复训练一直持续至术后半年，强度随时间增加而加大。术后8h至术后7周在康复训练同时进行中医治疗：术后8h，2-4d内服膝伤1号方（黄连、黄芩、蒲公英、牛膝、郁金、酒军等），1剂／d，分3次口服。术后第2天同时行指针治疗，点揉足三里、阳陵泉、三阴交等穴，每穴15s，每次约10min。1次／d。术后第3天：中医外治法：指针治疗，选用足三里、阳陵泉、阴陵泉等穴，方法同前。电针治疗，选用足三里、阳陵泉、阴陵泉等穴交替使用，频率80次／min。术后第4天：中医外治法：指针治疗，选用足三里、阳陵泉、阴陵泉、三阴交、承山等穴，方法同前。电针治疗，方法与穴位同前。于术后第5~11天服用中药膝伤2号方（桃仁、当归、赤芍、川牛膝、木通、续断、白芨、香附、川黄连等）。1剂／d，分3次口服，连服7d，外治法：指针、电针治疗，穴位、方法同前。从术后第12天，开始服用中药膝伤3号方（黄芪、党参、地龙、木通、肉苁蓉、菟丝子、桑寄生、金毛狗脊、千年健、木瓜等），1剂／d，分3次口服。外治法：指针及电针治疗，方法同前。术后4-7周：中医内外治法：对症给予中药，配合指针点穴。术后8～12周：强化肌力训练。术后12周～6个月：恢复全部功能。康复训练组：常规术后康复训练同另组，不用中医方法治疗。③于术前，术后3，7，14，3个月采用目测类比评分进行量化评定休息和活动时疼痛程度，不痛为0，最痛为10．0。④于术后第3，4，17天行膝关节腔穿刺抽液观察关节肿胀程度。⑤于术前、术后7，14，3个月用骨关节量角器测量关节活动度。于术前、术后3个月采取询问方式应用Lysholm评分系统评估患者膝关节功能（总分0—100分，分数越高表示膝关节功能状况越好）。⑥于术前、术后3个月采用国际膝关节病例记载委员会-2000评分系统评估患者症状、膝关节功能、运动能力（采用分数积分法，以1代表最低水平的功能或最严重的症状。分数越高功能越好，症状越轻）。⑦计量资料差异比较采用t检验。 结果：膝前交叉韧带重建术后患者32例均进入结果分析。①中医治疗＋康复训练组患者术后3和7d休息痛和活动痛疼痛程度明显低于康复训练组（P〈0．05），术后14d活动痛疼痛程度明显低于康复训练组（P〈0．05）。②中医治疗＋康复训练组患者术后7d和3个月关节活动度明显大于康复训练组（P〈0．05）。③两组术后3，7，14d关节肿胀程度比较，差异不明显（P〉0．05）。④两组术后3个月膝关节功能评分均明显高于术前（P〈0．05），中医治疗＋康复训练组术后3个月明显高于康复训练组（P〈0．05）。⑤两组术前、术后3个月国际膝关节病例记载委员会-2000评分系统评分结果比较，差异不明显（P〉0．05）。 结论：早期中西医结合康复训练可减轻关节镜下膝前交叉韧带重建术后患者疼痛、膝关节肿胀程度，改善膝关节功能，作用效果优于单纯康复训练。     

Neuromuscular training versus strength training during first 6 months after anterior cruciate ligament reconstruction: a randomized clinical trial

BACKGROUND AND PURPOSE: The purpose of this study was to determine the effect of a 6-month neuromuscular training (NT) program versus a traditional strength training (ST) program following anterior cruciate ligament (ACL) reconstruction. SUBJECTS: Seventy-four subjects with ACL reconstruction participated in the study. METHODS: The study was a randomized, single-blinded, controlled trial. The NT and ST groups were tested preoperatively and at 3 and 6 months. The main outcome measure was the Cincinnati Knee Score. Secondary outcome measures were visual analog scales (VASs) for pain and function, the 36-Item Short-Form Health Survey (SF-36), hop tests, isokinetic muscle strength, proprioception, and static and dynamic balance tests. RESULTS: The NT group demonstrated significantly improved Cincinnati Knee Scores and VAS scores for global knee function compared with the ST group at the 6-month follow-up. There were no significant differences between the groups for the other outcome measures (ie, hop, balance, proprioception, and muscle strength tests). DISCUSSION AND CONCLUSION: The results of this study suggest that exercises included in the NT program should be part of the rehabilitation program following ACL reconstruction.     

关节镜下半腱肌和股薄肌双束重建前交叉韧带后膝关节本体感觉的功能评定

背景;前交叉韧带重建是前交叉韧带损伤的主要治疗方案,近年来,前交叉韧带重建后膝关节本体感觉的研究进展迅速.目的:对关节镜下半腱肌和股薄肌双束重建膝关节前交叉韧带后的本体感觉进行评定.设计、时间及地点:病例对照,于2007-08/2008-06在潍坊医学院附属医院骨科完成.对象:用14例关节镜下半腱肌和股薄肌双束重建前交叉韧带的男性患者作为试验组和14例健康男性作为对照组.方法:所有患者前交叉韧带重建都经过12个月神经肌肉康复训练,通过在负重的条件下屈伸运动重现设定的角度来评定关节的位置觉,测试健康的受试者和患者的双膝伸膝运动、屈膝运动关节位置重现偏差.主要观察指标:患者的患侧膝关节、健侧膝关节和健康受试者膝关节在伸膝运动和屈膝运动时主动关节位置重现测试的比较.结果:患者患膝与健膝关节位置重现偏差、患者侧膝与健康者关节位置重现偏差及患者健膝与健康者关节位置重现偏差比较,差异均无显著性意义(P0.05).结论:前交叉韧带重建后12个月的患膝和健康膝关节在承重条件下的位置觉无明显差别.     

Rehabilitation after first-time anterior cruciate ligament injury and reconstruction in female football players: a study of resilience factors

Background

Most of the research in the area of psychosocial factors in rehabilitation after sports injuries has focused on risk behaviors, while relatively few studies have focused on behaviors that facilitate rehabilitation. The objective of our study was to understand the psychosocial features that characterize elite female football players who express a resilient behaviour during rehabilitation after a first-time anterior cruciate ligament (ACL) injury and reconstruction.

Methods

A qualitative method was used based on individual in-person interviews and video communication of players who incurred a first-time ACL tear during the 2012 season of the Swedish Women’s Elite Football League. In total, 13 players had a first-time ACL and were interviewed post-season. The interviews were followed by a thematic content analysis. Based on this, eight players were identified as showing resilient behaviors during their rehabilitation and were included in the final analysis.

Results

Three core themes representing psychosocial factors that help players cope successfully with rehabilitation were identified: (I) constructive communication and rich interaction with significant others; (II) strong belief in the importance and efficacy of one’s own actions; and (III) the ability to set reasonable goals.

Conclusions

The findings suggest three core themes of psychosocial factors that characterize first-time ACL-injured elite female football players showing resilience during rehabilitation after ACL reconstruction. Suggestions for medical teams about ways to support communication, self-efficacy, and goal-setting during the rehabilitation process, are provided.

     

Neuromuscular training improves knee proprioception in athletes with a history of anterior cruciate ligament reconstruction: A randomized controlled trial

BackgroundAthletes exhibit deficits in knee proprioception following anterior cruciate ligament reconstruction. Neuromuscular training programs improve knee proprioception in uninjured athletes; however, the effects on knee proprioception in athletes who have undergone anterior cruciate ligament reconstruction is not well understood. The purpose of this study was to examine the effects of a neuromuscular training program on knee proprioception in athletes who have returned to sport following anterior cruciate ligament reconstruction.MethodsTwenty-four male athletes, who had undergone anterior cruciate ligament reconstruction within the previous 6–12 months and returned to sport, participated in this randomized controlled trial. Athletes were randomly allocated to an experimental group (n = 12) that took part in an 8-week neuromuscular training program or a control group (n = 12) that simply continued their typical training routine. Knee position sense was assessed at baseline and after the 8-week period (post-testing). One-way analysis of covariance, with baseline performance included as a covariate, was used to compare knee position sense errors for the reconstructed limbs of the experimental and control groups at the post-testing time point.FindingsKnee position sense errors decreased by 51.7% for the experimental group and only 4.4% for the control group over the 8-week period. As a result, the experimental group demonstrated lower knee position sense errors, compared to the control group, at the post-testing time point (P < .001).InterpretationAthletes with a history of anterior cruciate ligament reconstruction may benefit from participation in a neuromuscular training program, even after completing post-operative rehabilitation.