监督下康复时长对前交叉韧带重建术后效果影响的系统综述
简介
该系统性综述分析了前交叉韧带重建（ACLR）后监督康复时长对肌力、功能表现及患者自评结局的影响。纳入9项研究（1项RCT、1项回顾性队列、7项横断面研究），结果显示：康复时长越长，膝关节肌力、功能测试（如跳跃测试）及患者自评功能评分（如IKDC、Lysholm）的改善趋势越明显。尽管证据质量有限，但现有数据支持ACLR后至少进行6个月的监督康复。临床意义：术…
英文摘要
BACKGROUND: Rehabilitation practices and recovery timelines are variable following anterior cruciate ligament reconstruction (ACLR). Elucidating associations between longitudinal temporal characteristics of rehabilitation and relevant functional outcomes following ACLR may help with improving outcomes and reducing re-injury risk. PURPOSE: The purpose of this systematic review was to analyze the effect of the duration of supervised rehabilitation on strength, functional performance, and self-reported outcomes following ACLR. METHODS: A systematic review was conducted in the PubMed, Embase, Scopus, CINAHL, and Pedro databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Search terms included terms pertaining to diagnosis (e.g., 'anterior cruciate ligament', 'ACL reconstruction'), rehabilitation (e.g., 'rehabilitation', 'physiotherapy', 'physical therapy'), and outcomes (e.g., 'functional status', 'return to sport', 'return to play'). Inclusion criteria were studies that 1) included patients who had undergone primary ACLR, 2) reported outcome measures of strength, physical performance testing (such as hop testing), and/or patient reported functional status, and 3) measurements of the duration of supervised rehabilitation following ACLR. Exclusion criteria included a lack of direct statistical comparison of the effect of rehabilitation duration on outcome measures, studies that were not available in full-text in the English language, or studies that were later retracted. The Downs and Black checklist was implemented to assess the quality of the studies included, and risk of bias was assessed with the ROBINS-I tool. RESULTS: Out of 5598 studies initially retrieved, 44 underwent full-text screening and nine studies (one randomized controlled trial, one retrospective cohort, and seven cross-sectional studies) met inclusion criteria and were included in this study. These studies showed trends for higher knee strength, improved performance testing, and greater self-reported outcomes with a longer duration of rehabilitation. There was considerable variety in the duration assessed and time points for when the outcomes were measured. CONCLUSIONS: Limited quality evidence exists to support supervised rehabilitation of at least six months in duration following ACLR for knee strength, performance testing, and patient-reported functional outcomes. LEVEL OF EVIDENCE: Level 3.