The Prevalence Type of the Meniscus Tear in Patients with Anterior Cruciate Ligament (ACL) Injury, in Abu Arish General Hospital, Jazan, KSA

Background: The anterior cruciate ligament (ACL) is the main structure that prevents the forward movement of the tibia about the femur Meniscus tear which is a common finding in patients with anterior cruciate ligament (ACL) injury. Aim: To investigate the prevalence of types of meniscus tears in patients with Anterior Cruciate Ligament (ACL) Injury. Methods: A retrospective study was conducted among inpatients. Clinical evaluation included side-to-side difference in anterior tibial translation (ATT) as measured by a KT-1000 arthrometer (MEDmetric Corp) and a grade of pivot-shift test at final follow-up in all patients. Subsequent meniscal tear was defined by symptoms of joint line pain and/or locking or joint effusion requiring surgical treatment. Results: Most of patients were males (92.6%). The patients were categorized into 5 groups according to age with a mean of age 32.8 ± 10.6. The most common causes of ACL injury were falling down (43.2%), trauma (38.1%) or knee torsion (18.8%). Medial meniscal tear was found in 92 knees (55.7%), while lateral meniscal tear was found in 19 knees (10.8%) and the most common type was the longitudinal tear that was found in 31 knees (17.6%). Similarly, 66.7% of the meniscal flap tears and half of the meniscal bucket-handle tears were significantly associated with loose body (P Conclusion: The present study demonstrated that meniscus tears are more common in individuals with chronic ACL rupture. The main factors contributing to ACL injury were classified as falls, trauma, and knee torsion. Gender was identified as a critical determinant in the etiology of ACL injury. The occurrence of a ramp lesion was associated longitudinal meniscal tears, whereas chodoral injury was associated with the majority of meniscal flap tears and meniscal bucket-handle tears.

Recent research progress from biological perspective on the mechanism of formation of osteoarthritis after anterior cruciate ligament injury

The anterior cruciate ligament(ACL)mainly plays a role in stabilizing the knee joint by limiting the forward translation of tibial force and rotational force at the tibial joint,and if this ligament is damaged,it will cause joint pain,limited mobility,knee instability,etc.According to related studies,the incidence of traumatic osteoarthritis(PTOA)after ACL injury is as high as 87%,although many studies have shown that patients with ACL injury are susceptible to PTOA,but the exact mechanism is currently unknown.This may be related to biological,structural,and mechanical factors caused by the ligament injury.Previous studies have shown that elevated inflammatory mediators in the joint cavity following ACL injury can lead to chondrocytes necrosis and degradation of the cartilage matrix.These potential biochemical mediators contribute to PTOA formation,and early intervention can reduce future episodes of PTOA.In recent years,many scholars have devoted themselves to studying the potential important factors and signaling pathways involved in the formation of osteoarthritis after ACL injury,and exploring its molecular mechanism,which has led to great progress in this field.This paper mainly studies and discusses the mechanism of osteoarthritis formation after ACL injury from the biological perspective.

Lateral femoral tunnel preparation and graft fixation for anterior cruciate ligament reconstruction–A discussion

This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction(ACLR),with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques.The paper explores and comments on a recently published review by Dai et al,titled"Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR",while providing insight into its relevance within the field of ACLR,and recommendations for future research.

Demographic characteristics of patients who underwent anterior cruciate ligament reconstruction at a tertiary care hospital in India

BACKGROUND Anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained by many sports leagues in their registries.However,very few nationwide registries exist for such injuries.This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.AIM To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.METHODS All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied.Patients with multi-ligament injuries or a history of previous knee surgery were excluded.The patients’history was obtained from the hospital records,they were interviewed telephonically,and online questionnaires were given.Their demographic data was analyzed and compared to the existing literature.RESULTS A total of 124 patients were operated on for ACL reconstruction during this period.The mean age of the patients was 27.97 years.One hundred and thirteen patients(91.1%)were male and 11(8.9%)were female.The majority of the patients(47.6%)sustained this injury by road traffic accidents(RTA)followed by sportsrelated injuries(39.5%).The commonest presenting complaint was giving way of the knee in 118 patients(95.2%).The mean duration from the injury to the first hospital visit among the patients was 290.1 d.The mean duration from the injury to surgery was 421.8 d.CONCLUSION ACL patients’demography is different in developing nations as compared to the developed world.RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause.There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery.This,in turn,leads to poorer prognosis and longer rehabilitation.National registries for developing nations are the need of the hour due to the different demographics of ACL injuries in developing countries.

Osteoarthritis action alliance consensus opinion-best practice features of anterior cruciate ligament and lower limb injury prevention programs

AIM To identify best practice features of an anterior cruciate ligament(ACL) and lower limb injury prevention programs(IPPs) to reduce osteoarthritis(OA).METHODS This consensus statement started with us performing a systematic literature search for all relevant articles from 1960 through January 2017 in PubM ed, Web of Science and CINAHL. The search strategy combined the Medical Subject Heading(Me SH) and keywords for terms:(1) ACL OR "knee injury" OR "anterior cruciate ligament";(2) "prevention and control" OR "risk reduction" OR "injury prevention" OR "neuromuscular training"; and(3) meta-analysis OR "systematic review" OR "cohort study" OR randomized. We found 166 different titles. The abstracts were reviewed for pertinent papers. The papers were reviewed by at least two authors and consensus of best practice for IPP to prevent OA was obtained by conference calls and e-mail discussions. All authors participated in the discussion.RESULTS The best practice features of an IPP have the following six components:(1) lower extremity and core strengthening;(2) plyometrics;(3) continual feedback to athletes regarding proper technique;(4) sufficient dosage;(5) minimal-to-no additional equipment; and(6) balance training to help prevent injuries. Exercises focused on preventing ankle sprains, hamstring injuries and lateral trunk movements are important. Plyometric exercises should focus on correcting knee valgus movement.Exercises should focus on optimizing the hamstring to quadriceps strength ratio. In order for IPP to be successful, there should be increased education and verbal feedback along with increased athletic compliance. Additional equipment is not necessary. Balance training alone does not significantly reduce injuries, but is beneficial with other exercises. Not enough evidence to recommend stretching and agility exercises, with no ill effects identified. Therefore, we suggest making these optional features.CONCLUSION Best practice features for ACL and lower limb IPPs to help prevent OA contain six key components along with two optional.

Preseason elimination impact on anterior cruciate ligament injury in the national football league

BACKGROUND Anterior cruciate ligament(ACL)injuries represent detrimental injuries in the National Football League(NFL).A significant portion of these injuries often occur in preseason exhibitions.The Coronavirus disease 2019 pandemic presented a unique disruption to preseason NFL football with the cancelation of all preseason games.AIM To compare the incidence of ACL tears through the first eight weeks of the NFL season in 2020 to the mean incidence over the previous 5 seasons(2015-2019)and determine if there was any change in incidence with the elimination of the preseason.METHODS NFL players who suffered ACL tears during the preseason and first eight weeks of the NFL season from 2015-2020 were identified.The number of ACL injuries for the 2015-2019 seasons was compared to the 2020 season for four different timeframes.For each analysis,the cumulative number of ACL injuries to that time point was used to calculate the percent difference for descriptive analysis.Additionally,the number of teams with at least one player suffering an ACL tear were identified and compared using Chi-Squared testing.Finally,a cumulative relative risk was calculated for each week played.RESULTS There were 14 ACL tears through the first four games of the 2020 season,a 118.8%(14 vs 6.4)increase in comparison to the 5-year average over the first 4 regular season weeks of 2015-2019.However,when accounting for injuries occurring during the preseason from 2015-2019,there were 18.6%(14 vs 17.2)fewer total ACL injuries through regular season week 4 with no significant difference in percentage of teams impacted when these preseason injuries were accounted for P=0.394.Results were similar(19 vs 17.2)over 8 total games played(whether regular season or preseason),and over 8 regular season games(P=0.196,P=0.600).CONCLUSION The elimination of the NFL preseason resulted in a higher rate of injuries during the first 4 games of the regular season.However,these increases are offset by the injuries typically sustained during the preseason.This suggests there may be front-loading of injuries over the course of an NFL season,such that players may be more prone to injury when the intensity of play suddenly increases,whether in the preseason or regular season.

Hamstring autograft utilization in reconstructing anterior cruciate ligament:Review of harvesting techniques,graft preparation,and different fixation methods

Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in 1934,and it remains a commonly harvested graft for ACL reconstruction.Hamstring autografts can be harvested using the traditional anteromedial approach or the newer posteromedial technique.An isolated semitendinosus tendon can be used or combined with the gracilis tendon.There are numerous methods for graft fixation,such as intra-tunnel or extra-tunnel fixation.This comprehensive review discusses the different hamstring muscle harvesting techniques and graft preparation options and fixation methods.It provides a comprehensive overview for choosing the optimal surgical technique when treating patients.

The 45-Degree Arthroscope Improves Visualization of the Femoral Attachment of the Anterior Cruciate Ligament

Background: Exposure of the insertion site of the anterior cruciate ligament (ACL) is important for appropriate tunnel placement in ACL reconstruction surgery. However, observing the femoral ACL insertion site via the standard anterolateral portal is sometimes difficult. In this study, we compared views of the femoral ACL insertion site between 30-degree and the 45-degree arthroscopes. Methods: We first inserted the 30-degree and the 45-degree arthroscope into the anterolateral portal of a knee simulator in which we had drawn a lattice pattern on the lateral intercondylar notch based on the quadrant method. Next, we compared the arthroscopic views provided by the 30-degree and 45-degree arthroscopes during ACL reconstruction surgery by measuring the area of the lateral intercondylar notch visible through each of the arthroscopes. Results: In the knee simulator, the 45-degree arthroscope showed the entire area of the lateral intercondylar notch, whereas the 30-degree arthroscope had to be introduced more deeply to show the most superior and posterior quadrant, where the attachment of the anteromedial bundle of ACL is located. During the ACL reconstruction, the area of the lateral intercondylar notch in the field of view was larger through the 45-degree arthroscope than through the 30-degree arthroscope. Conclusion: The 45-degree arthroscope provides a better view of the femoral ACL insertion site via the anterolateral portal, which may be helpful during ACL reconstruction.

以ERAS理念为导向的阶梯式康复护理在膝关节ACL损伤患者中的应用效果及其对疼痛、膝关节功能恢复的影响

目的探讨以加速康复外科(ERAS)理念为导向的阶梯式康复护理在膝关节前交叉韧带(ACL)损伤患者中的应用效果及其对疼痛、膝关节功能恢复的影响。方法选取2021年2月至2022年2月接受治疗的78例膝关节ACL损伤患者,通过随机数字表法将其分为对照组和观察组,每组39例。对照组行常规护理,观察组于常规护理基础上展开以ERAS理念为导向的阶梯式康复护理。比较两组的康复训练依从性、并发症发生情况、膝关节疼痛与肿胀情况及膝关节功能恢复情况。结果观察组的康复训练总依从率为94.87%,高于对照组的76.92%(P<0.05)。观察组的并发症总发生率为5.13%,低于对照组的20.51%(P<0.05)。术后7 d,观察组的视觉模拟评分法(VAS)评分、肿胀值低于对照组(P<0.05)。干预后,观察组的Lysholm膝关节各方面评分高于对照组(P<0.05)。结论以ERAS理念为导向的阶梯式康复护理可提升膝关节ACL损伤患者的康复训练依从性,有效缓解其疼痛、肿胀症状,减少并发症的发生,并促进膝关节功能有效恢复。

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

Background:Knee examination guidelines in minors are intended to aid decisionmaking in the management of knee instability.Clinical question:A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence.A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children.Key findings:there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary.Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed.Clinical application:In the absence of a strong evidence base,these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible.Following this expert consensus,surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test++,and may include an anterior drawer test+and a Lachman test+.If these conditions are not present,the conservative approach should be chosen,as the anatomical and functional development of children,together with a physiotherapy programme,may improve the evolution of the injury.

Five Strand Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction Provides No Benefit over the Gold Standard Four Strand Repair for Anterior Stability of the Knee: A Prospective Cohort Study

The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand hamstring graft, may provide greater strength and a larger scaffold for incorporation of the graft into the bone tunnels, leading to greater postoperative anterior stability of the knee. 28 (n = 18 Four-Strand and n = 10 Five-Strand) patients with planned ACL reconstructive surgery by a single surgeon were recruited for this study. The KT-1000 Arthrometer (MED metric, CA, USA) was used to quantify AP translation in the subjects’ knees before (T0) and after surgery at 6 (T1) and 12 (T2) weeks. At 12 weeks there was significantly higher (p = 0.01) mean anterior laxity on Maximum Manual Test in the Five- Strand group (9.1 ± 1.7 mm) than the Four Strand Group (6.9 ± 2.3 mm). Further, there were significantly higher mean side-to-side differences (p = 0.01) on Maximum Manual Test in the Five-Strand cohort (5.1 ± 3.5 mm) compared to the Four-Strand cohort (1.9 ± 2.2 mm). A significantly larger positive mean change in anterior laxity (p = 0.02) from 6 - 12 weeks was evident in the Five-Strand group (1.4 ± 0.9) than the Four-Strand group (-0.3 ± 1.9 mm). No significant correlations were seen between graft widths and measures of anterior stability on KT-1000. This study illustrated that there was no benefit to using a Five-Strand Hamstring Tendon Autograft when compared to the gold standard Four-Strand Repair specifically with regards to anterior stability of the knee.

Biomechanical comparison of single-tunnel double-bundle and single-bundle reconstruction of anterior cruciate ligament

Objective To compare the difference in stability of the knee joint after single-tunnel double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction.Methods Six formalin-soaked specimens of the human knee with retained

Applying the Socio-Ecological Model to barriers to implementation of ACL injury prevention programs: A systematic review

Background: Preventing anterior cruciate ligament(ACL) injuries is important to avoid long-term adverse health consequences. Identifying barriers to implementation of these prevention programs is crucial to reducing the incidence of these injuries. Our purpose was to identify barriers of implementation for ACL injury prevention programs and suggest mechanisms for reducing the barriers through application of a SocioEcological Model(SEM).Methods: Studies investigating ACL prevention program effectiveness were searched in Medline via PubMed and the Cochrane Library, and a subsequent review of the references of the identified articles, yielded 15 articles total. Inclusion criteria encompassed prospective controlled trials, published in English, with ACL injuries as the primary outcome. Studies were independently appraised by 2 reviewers for methodological quality using the PEDro scale. Barriers to implementation were identified when reported in at least 2 separate studies. A SEM was used to suggest ways to reduce the identified barriers.Results: Five barriers were identified: motivation, time requirements, skill requirements for program facilitators, compliance, and cost. The SEM suggested ways to minimize the barriers at all levels of the model from the individual through policy levels.Conclusion: Identification of barriers to program implementation and suggesting how to reduce them through the SEM is a critical first step toward enabling ACL prevention programs to be more effective and ultimately reducing the incidence of these injuries.

Functional Outcomes for Combined Acute Anterior and Posterior Cruciate Knee Injuries Treated Non-Operatively

Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligament injury. Methods: non-operative management consisted of employing a brace to prevent sagittal translation of the tibia. Quadriceps muscle and early passive knee motion exercises in the brace was encouraged immediately after arthroscopy. Weight-bearing was forbidden for 3 weeks. The brace was not removed for 3 months. Follow-up periods ranged from 2 to 6 years (mean, 3 years 2 months). Results: none, but one patient had a slight restriction of knee flexion. Quadriceps muscle strength revealed an average of 89.0% of normal side. The knee score indicated 2 patients rated good, 3 rated fair, and 8 rated poor. The score correlated with measurements of anterior and posterior translation on the stress radiograph significantly. Stress radiography revealed that anterior laxity was reduced better than posterior laxity significantly. Conclusion: non-operative brace therapy can be considered for this combined injury as the initial treatment. A late reconstruction would be performed when the result was not satisfactory. Preserved range of motion and muscle strength after brace therapy had a great advantage to the late reconstructive surgery.

不同类型篮球运动员ACL损伤危险因素的随机生物力学模型分析

篮球运动员常面临前交叉韧带(ACL)损伤的风险,这种损伤会对运动员的职业生涯产生严重影响。本文采用随机生物力学模型,对专业和非专业的篮球运动员进行比较分析,探讨影响ACL损伤的各种因素,如运动员的身体素质、技术水平、训练方法和使用的装备等。研究结果:男性和女性篮球运动员在多个下肢生物力学特征上存在显著差异,这些差异可能与ACL损伤的风险有关;并且女性的ACL损伤率高于男性。此发现可为篮球运动员的训练和康复提供参考和借鉴。

前交叉韧带重建后肌肉等长发力率及与功能表现的关系

背景:前交叉韧带重建后肌肉功能的恢复通常评估肌肉的最大力量,最近的研究认为还应考虑神经肌肉功能,比如肌肉等长发力率,即在肌肉等长收缩条件下测量不同时间间隔的力-时间曲线斜率。目的:阐述前交叉韧带重建后患者肌肉等长发力率的研究现状与不足,分析术后不同时间内股四头肌和腘绳肌等长发力率的缺陷程度;等长发力率对术后患者功能表现的影响,为优化前交叉韧带重建后康复、减少患者二次损伤以及降低膝骨关节炎发生率提供重要信息。方法:检索中国知网、维普、万方和PubMed数据库,以“前交叉韧带,发力率”为中文检索词,以“anterior cruciate ligament,rate of force development,rate of torque development”为英文检索词,按照纳入和排除标准最终纳入69篇文献。结果与结论:(1)大多数研究发现前交叉韧带重建后半年内患者双侧肌肉等长发力率存在缺陷,双侧腘绳肌早期等长发力率(即肌肉收缩100 ms时间段内任意时间间隔的力-时间曲线斜率)在半年后有显著改善,但双侧股四头肌早期等长发力率长期缺陷,表明术后股四头肌神经肌肉功能长期受损。(2)有关晚期等长发力率(肌肉收缩100 ms后时间段内任意时间间隔的力-时间曲线斜率)的相关研究较少,无法得出确切结论。(3)关于着陆运动(跳跃落地和侧切等)和日常生活活动(走、跑),股四头肌早期等长发力率比等长峰值力矩相关性更强,运动过程中生物力学的异常改变被认为是患者二次损伤以及创伤性膝骨关节炎发生的重要风险因素,积极改善股四头肌早期等长发力率可能会降低二次损伤以及创伤性膝骨关节炎的发生率。(4)目前仅有很少的证据表明,全身振动训练能改善前交叉韧带重建后患者股四头肌早期等长发力率,建议今后在术后早期阶段应用神经肌肉电刺激干预股四头肌和腘绳肌,而在术后晚期阶段实施爆发力、高阻力训练,这可能会改善患者等长发力率。(5)短时间产生足够的肌肉力量才能有效保护前交叉韧带,而腘绳肌等长发力率与功能表现的关系尚不清楚,这可能会提供有关预防患者二次损伤的信息。(6)作者建议将等长发力率作为指导康复以及恢复运动的评估指标之一,除了关注对称性的改善以及与正常人的差异,还要考虑腘绳肌与股四头肌力量的比值,合适的比值范围才能保证肌肉快速发力时的平衡,这可能会降低再次损伤的发生,但比值的正常范围尚不清楚。(7)未来研究要考虑移植物类型和膝关节屈曲角度对等长发力率的影响,以尽可能找出患者存在的神经肌肉功能障碍,帮助患者更好地康复。

前交叉韧带重建术后三种不同药物镇痛早期疗效的对比

目的:比较去痛片(复方氨基比林、非那西丁片,商品名去痛片)、盐酸曲马多缓释片(商品名:奇曼丁)及盐酸哌替啶(商品名:杜冷丁)在膝关节前交叉韧带自体肌腱单束重建术后早期的止疼效果及安全性。方法:回顾性分析2018年11月至2019年2月,北京大学第三医院连续收治的45例由同一组医师施行膝关节镜下前交叉韧带自体肌腱单束重建术患者,术后疼痛情况和使用药物镇痛情况的临床资料。采用随机区组设计,根据前交叉韧带断裂是否合并半月板损伤将患者分为两组,A组为单纯膝关节前交叉韧带重建的患者24例,B组为前交叉韧带断裂合并半月板损伤的患者21例。两组又根据患者实际使用的术后镇痛药物各分为3组,其中,A组口服去痛片4例、口服奇曼丁11例、肌肉注射(简称肌注)杜冷丁联合盐酸异丙嗪(商品名:非那根)9例;B组口服去痛片3例、口服奇曼丁10例、肌注杜冷丁联合非那根8例。术后早期,患者诉疼痛并主动要求镇痛时随机给予去痛片、奇曼丁或杜冷丁联合非那根这三种不同的止痛药物缓解疼痛,采用疼痛视觉模拟评分(visual analogue scale, VAS)评估疼痛缓解情况,并观察不良反应发生情况。结果:患者在性别、年龄、体重指数、住院时间等基本情况上差异无统计学意义(P>0.05)。应用三种止痛药物缓解疼痛的两组患者,在用药前及用药1 h后通过VAS评分判断结果表明,患者疼痛情况明显缓解,用药前后疼痛差异有统计学意义(P<0.05)。对两组患者应用的三种药物进行两两比较显示,杜冷丁联合非那根组对于疼痛缓解的程度显著高于其余两种药物(P<0.05),用药1 h后,两组差异无统计学意义(P>0.05)。应用杜冷丁患者易出现恶心、呕吐等副反应,但应用杜冷丁的同时使用非那根可减少副反应。在不良反应方面,仅单纯前交叉韧带重建组中应用奇曼丁组的患者出现恶心1例,其余各组患者均未出现严重的并发症及过敏反应。结论:无论是单纯交叉韧带重建,还是合并半月板成型或缝合的交叉韧带重建,患者应用去痛片、奇曼丁、杜冷丁联合非那根这三种药物均能有效缓解疼痛,其中杜冷丁对疼痛的缓解幅度最大。应用杜冷丁的同时,合用非那根可有效减轻患者的呕吐、恶心等不良反应,增加用药安全性。

两种股骨隧道技术在前交叉韧带全内重建中的疗效比较

目的比较关节镜下前交叉韧带(anterior cruciate ligament,ACL)全内重建中,由外向内技术和经前内侧入路技术制作股骨隧道对术后临床疗效的差异。方法收集2020年2月至2022年6月徐州市中心医院运动医学科收治的60例ACL断裂患者,根据手术技术的不同,分为观察组(由外向内技术)30例和对照组(经前内侧入路技术)30例。其中观察组男20例,女10例;年龄24~37岁,平均(29.30±4.00)岁;对照组男17例,女13例;年龄23~40岁,平均(29.70±4.21)岁;比较两组患者术前、术后6个月、12个月膝关节Lysholm评分和美国膝关节协会评分(knee society score,KSS);比较两组患者术前和末次随访膝关节松弛度;随访期间记录两组患者伤口感染、肌腱松动、术后再次翻修等情况。结果所有患者均获随访,随访时间12~18个月,观察组平均随访(15.37±1.61)个月,对照组平均随访(14.97±1.56)个月;术后12个月,观察组膝关节前抽屉试验、Lachman试验和轴移试验结果与对照组患者相似,差异无统计学意义(P>0.05);术后6个月和12个月两组患者膝关节Lysholm评分和KSS评分相似,差异无统计学意义(P>0.05);随访期间,两组患者均未发生伤口感染、肌腱松动、术后再次翻修等情况。结论ACL全内重建中,选择经前内侧入路技术或由外向内技术制作股骨隧道均能实现股骨隧道的解剖定位,术后两组患者膝关节功能恢复良好,短期疗效均可接受。

中老年患者前交叉韧带重建术后行“精细个体化”康复教育的疗效分析

目的分析中老年患者前交叉韧带重建术后行“精细个体化”康复教育的疗效。方法选择接受前交叉韧带重建的中老年患者68例,根据术后的康复方式将其分为试验组(n=36)和对照组(n=32)。对照组患者接受常规康复功能锻炼,试验组患者接受“精细个体化”的康复教育指导模式下的康复功能锻炼。手术半年后,比较两组患者的膝关节功能恢复和并发症情况。结果经过半年的随访,试验组患者的膝关节功能(IKDC)评分和膝关节Lysholm评分明显高于对照组,差异均有统计学意义(t分别=10.19、7.94,P均<0.05)。在膝关节视觉模拟评分(VAS)和膝关节稳定性(前抽屉试验和Lachman试验)方面,两组比较,差异均无统计学意义(t=-0.33,χ^(2)分别=0.79、1.35,P均>0.05)。两组患者在手术过程中均未出现因大血管神经损伤或灌注液外渗导致下肢筋膜腔水肿,术后也无发生感染、血肿、血栓等并发症。结论前交叉韧带重建术后,中老年患者需要接受健康教育和“精细个体化”的康复指导,可以显著提升康复效果并改善预后。

核心稳定性训练降低落地动作前交叉韧带损伤的风险

背景:研究表明,动态姿势控制能力较差可能导致运动时产生异常的动作模式,进而可能增大下肢关节及前交叉韧带的损伤风险,而躯体核心的稳定是良好动态姿势控制能力的基础。目的:探讨核心稳定性训练对大学生动态姿势控制能力及落地动作损伤风险的影响,并对比不同性别训练效果差异。方法:招募35名(男=19,女=16)大学生为试验对象,对其进行6周核心稳定性训练,分析训练前后Y平衡测试、躯干伸肌耐力测试、躯干屈肌耐力、侧桥肌群耐力测试和落地错误评分系统(LESS)测试结果的差异。结果与结论:①6周核心稳定性训练可提高男女大学生的躯干伸肌耐力(P<0.001)、屈肌耐力(P<0.001)和侧桥肌群耐力(P<0.001);②核心稳定性训练可提高男女大学生Y平衡测试前向测试距离(P=0.026)、后内向距离(P<0.001)、后外向距离(P=0.005)和综合得分(P<0.001);③经过6周核心稳定性训练,男女大学生LESS评分均显著下降(P<0.001),同时可增大触地时刻膝关节(P<0.001)、髋关节屈曲角(P<0.001),减小触地时刻膝关节外翻角(P<0.001),并可增大最大屈膝角(P<0.001)和减小最大膝外翻角(P<0.001);④结论:核心稳定性训练可提高动态姿势控制能力并改善落地动作模式,提示可能有助于降低前交叉韧带损伤风险;核心稳定性训练在提高躯干屈肌耐力、侧桥肌群耐力、改善动态姿势控制能力以及降低前交叉韧带损伤风险方面无性别差异。