Anterior cruciate ligament injury rehabilitation in athletes - Biomechanical considerations
Anterior cruciate ligament injury rehabilitation in athletes - Biomechanical considerations
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DOI：
10.2165/00007256-199622010-00005
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发表时间：
1996-07-01
期刊：
影响因子：
9.8
通讯作者：
Johnson, RJ
中科院分区：
文献类型：
--
作者：
Beynnon, BD;Johnson, RJ
术后康复是前交叉韧带（ACL）重建手术成功的主要因素，对ACL重建后患者的临床研究表明，膝关节固定或无肌肉收缩的受限运动会导致膝关节周围的关节、韧带和肌肉组织结构的不良结果。减少疼痛、关节囊收缩、关节软骨，并最大限度地减少限制关节运动的瘢痕形成，这些发现，结合具有与正常ACL相似的生物力学特性的移植材料，以及足够的固定强度，导致许多人推荐积极的康复计划，包括收缩占主导地位的股四头肌。最近，一项前交叉韧带重建术后康复的随机研究提供了证据，（足部固定抵抗阻力）导致前后膝关节松弛值与对侧正常膝关节相似，此外，开放式运动链练习（脚不固定抵抗阻力）导致与正常膝关节相比增加的前后膝关节松弛，由于康复训练与ACL移植物愈合反应之间的关系目前尚不清楚，因此必须遵守标准。在动物身上进行的ACL移植物愈合的生物力学研究表明，移植物需要较长的时间移植物的生物力学行为永远不会恢复正常。在非承重条件下，当前向剪切载荷和内部扭矩施加到膝关节时，功能性膝关节支具对ACL提供保护性应变屏蔽效应。然而，功能支具的应变屏蔽效应随着施加于膝关节的前向剪切和内扭矩的增加而降低。未来的研究应努力确定在各种康复训练过程中通过膝关节传递的实际载荷和ACL移植物应变，并将其与膝关节和移植物的愈合反应联系起来。
Postoperative rehabilitation is a major factor in the success of an anterior cruciate ligament (ACL) reconstruction procedure, Clinical investigations of patients after ACL reconstruction have shown that immobilisation of the knee, or restricted motion without muscle contraction, leads to undesired outcomes for the articular, ligamentous, and musculature structures that surround the knee.Early joint motion is beneficial for; reducing pain, capsular contractions, articular cartilage, and for minimising scar formation that limit joint motion, These findings, combined with graft materials that have biomechanical properties similar to the normal ACL, and adequate fixation strength, have led many to recommend aggressive rehabilitation programmes that involve contraction of the dominant quadriceps muscles.Recently a prospective, randomised study of rehabilitation following ACL reconstruction has presented evidence that a closed kinetic chain exercise programme (foot fixed against a resistance) results in anterior-posterior knee laxity values that ale similar to the contralateral normal knee, Also, open kinetic chain exercises (foot not fixed against a resistance) result in increased anterior-posterior knee laxity compared with the normal knee, Criteria must be observed because the relationship between rehabilitation exercises and the healing response of an ACL graft is unknown at present.Biomechanical studies of healing ACL grafts performed in animals have shown that the graft requires a long time to revascularise and heal, and that the biomechanical behaviour of the graft never returns to normal. Functional knee braces provide a protective strain-shielding effect on the ACL when anterior shear loads and internal torques are applied to the knee in the non-weight-bearing condition. However, the strain shielding effect of functional braces decrease as the magnitude of anterior shear and internal torque applied to the knee increase. Future studies should strive to determine the actual loads transmitted across the knee and ACL graft strain during various rehabilitation exercises and relate these to the healing response of the knee and graft.