Activity level and subjective knee function 15 years after anterior Cruciate ligament injury -: A prospective, longitudinal study of non reconstructed patients
Activity level and subjective knee function 15 years after anterior Cruciate ligament injury -: A prospective, longitudinal study of non reconstructed patients
复制标题
前十字韧带损伤后 15 年的活动水平和主观膝关节功能 -：针对非重建患者的前瞻性纵向研究
DOI：
10.1177/0363546507299238
复制
发表时间：
2007-07-01
影响因子：
4.8
通讯作者：
Roos, Harald
中科院分区：
文献类型：
--
作者：
Kostogiannis, Loannis;Ageberg, Eva;Roos, Harald
工作背景：前交叉韧带（ACL）损伤后不进行重建治疗的活动水平和主观膝关节功能尚未得到很好的阐明。假设：ACL损伤患者通过早期活动调整结合康复治疗，可以获得良好的膝关节功能和令人满意的长期活动水平。研究设计：队列研究材料与方法：对100例急性ACL损伤患者进行15年的临床观察。所有患者最初均接受关节镜手术和康复计划。建议他们调整活动水平，特别是避免接触性运动。随后排除了需要固定的复发性屈服发作和/或继发性踝关节损伤患者（n = 6），并进行了重建（n = 22）。67例单侧非重建ACL损伤的患者在15年随访时仍然存在。定期记录Lysholm膝关节评分、Tegner活动水平和整体膝关节功能的视觉模拟评分。在最后一次随访时，患者进一步评估与膝关节损伤和骨关节炎结局评分（KOOS）和国际膝关节文献委员会（IKDC）的主观膝关节evaluationform.Results：40例患者恢复其伤前活动水平或更高的3年内。根据Tegner活动量表，受伤后15年的中位活动水平从7降至4（P < .001）。伤后1年和3年的平均Lysholm膝关节评分分别为96和95，但15年后下降至86（P < .001）。15年时，49例患者的结果良好/极佳，14例患者的功能一般（n = 6）或较差（n = 8）。接触性运动损伤患者的KOOS生活质量子量表得分低于非接触性运动损伤患者（P <0.05）。67例患者中有13例（19%）因膝关节症状而再次手术，结论：早期活动调整和神经肌肉康复治疗使大多数非重建患者的膝关节功能良好，活动水平可接受。在受伤时从事接触性运动的患者活动水平的下降比参与非接触性运动的患者更影响他们的主观生活质量。
Background: The activity level and subjective knee function after an anterior cruciate ligament (ACL) injury treated without reconstruction have not been well elucidated.Hypothesis: Patients with ACL injury can achieve good knee function and satisfactory long-term activity level when treated by early activity modification combined with rehabilitation.Study Design: Cohort study (prognosis); Level of evidence, 2.Materials and Methods: One hundred patients with an acute total ACL injury were observed for 15 years. All patients initially underwent arthroscopic surgery and a rehabilitation program. They were advised to modify their activity level, especially by avoiding contact sports. Patients with recurrent giving-way episodes and/or secondary meniscal injuries that required fixation (n = 6) were subsequently excluded and underwent reconstruction (n = 22). Sixty-seven patients with unilateral nonreconstructed ACL injury remained at the 15-year follow-up. The Lysholm knee score, Tegner activity level, and a visual analog score for global knee function were recorded at regular intervals. At the final follow-up, patients were further evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective knee evaluation form.Results: Forty patients resumed their preinjury activity level or higher within 3 years. The median activity level 15 years after injury had decreased from 7 to 4 according to Tegner activity scale (P < .001). The mean Lysholm knee score was 96 and 95, 1 and 3 years after injury, respectively, but declined to 86 after 15 years (P < .001). Forty-nine patients had good/excellent results, and 14 had fair (n = 6) or poor function (n = 8) at 15 years. Patients injured in contact sports scored lower in the quality of life subscale of KOOS than those injured in noncontact sports (P < .05). Thirteen of the 67 patients (19%) were reoperated with an arthroscopic procedure because of knee symptoms.Conclusion: Early activity modification and neuromuscular rehabilitation resulted in a good knee function and an acceptable activity level in the majority of the non reconstructed patients. The decline in activity level of patients engaged in contact sports at the time of injury affected their subjective quality of life more than patients involved in noncontact sports.