前交叉韧带损伤是手术还是保守治疗？

The anterior cruciate ligament(ACL) is important for maintaining stability of the knee joint, particularly in activities involving weaving, pivoting or kicking. Injuries to the ACL are relatively common knee injuries among athletes occurring commonly in those who play sports such as football, skiing and gymnastics.

After sustaining an (ACL) there are two option, surgery or conservative management, both have pros & cons and both require extensive rehabilitation. Typically though, operative treatment is predicted to have a favorable outcome over conservative management in those who are;under 35’s; those who are physically active; those who have a better education and those with additional soft tissue injury.

The study included 300 participants who did not undergo ACL Reconstruction and 182 who did. All participants had a diagnosis of unilateral ACL rupture diagnosed by MRI, participants were between the ages of 13 -60 and participated in regular physical activity. They were excluded if they had suffered additional soft tissue injury during the rupture or had previous traumatic injuries to the knee.

A successful 2-year outcome was defined as having 2-year International Knee Documentation Committee (IKDC) scores ≥15th normative percentile and not undergoing ACL reconstruction. 

Multivariable logistic regression models were built using demographic and knee function data (quadriceps muscle strength, 4 single-leg hop tests, IKDC score, and Knee Outcome Survey–Activities of Daily Living Scale [KOS-ADLS] score) collected at baseline or after a 5-week neuromuscular and strength training (NMST) rehabilitation program.

After the 5-week  rehabilitation program, testing was repeated and surgical or nonsurgical treatment decided. If the participant experienced instability or wished to return to sports which involved jumping, cutting or pivoting, surgical reconstruction was advised regardless of progress of outcome measures.

The rehab program consisted of single- and multiple-joint exercises; open and closed kinetic chain exercises; and concentric, eccentric, and isometric exercises with 3 to 4 sets and 6 to 8 repetitions per exercise. Plyometric exercises were gradually progressed. These exercises focused on the quality of movement and were tailored to individual patient needs based on that patient’s specific goals. 

Perturbation training was performed according to the study protocol and consisted of dynamic stability exercises on a roller board, rocker board, and platform. To see the details of the plan click the buttons below.