前交叉韧带重建术后关节源性肌肉抑制的术前及术后危险因素：一项回顾性研究
简介
本研究旨在明确ACL重建术后关节源性肌肉抑制（AMI）的术前与术后危险因素。回顾性分析了169例接受腘绳肌腱自体移植物ACL重建联合前外侧韧带重建的患者。结果显示，AMI总发生率为33.7%，术前、术后45天和90天的发生率分别为15%、22%和18%。术前危险因素包括：关节积液（OR=8.97）、桶柄状半月板撕裂（OR=5.24）、膝关节屈曲活动度减小以及…
英文摘要
PURPOSE: This study aimed to identify preoperative and postoperative risk factors associated with the development of arthrogenic muscle inhibition (AMI) in patients undergoing anterior cruciate ligament reconstruction (ACLR). The hypothesis was that distinct risk factors contribute to the occurrence of preoperative and postoperative AMI. METHODS: A retrospective cohort study included 169 patients who underwent ACLR using a hamstring autograft combined with anterolateral ligament reconstruction between November 2022 and December 2023. AMI was clinically assessed preoperatively (t0), and at 45 days (D45) and 90 days (D90) postoperatively. Demographic, clinical and perioperative variables were collected. A combination of descriptive statistics and inferential tests was used, followed by univariate and stepwise multivariable logistic regression to identify independent predictors of AMI. RESULTS: AMI was observed in 33.7% of patients. Its prevalence was 15% at t0, 22% at D45 and 18% at D90. Preoperatively, patients with AMI demonstrated reduced knee flexion range (p < 0.001) and a shorter delay between injury and consultation (p < 0.001); AMI was significantly associated with joint effusion (odds ratio [OR] = 8.97; p < 0.001) and bucket-handle meniscal tears (OR = 5.24; p = 0.016). Postoperatively, significant predictors included female sex (OR = 2.98; p = 0.009), lateral femorotibial cartilage lesions (OR = 8.63; p = 0.004) and preoperative AMI (OR = 3.56; p = 0.008). Pain intensity was not significantly associated with AMI at any assessment point (not significant [n.s.]). CONCLUSION: AMI affects approximately one-third of patients undergoing ACLR and may persist for at least three months postoperatively. Distinct preoperative and postoperative risk factors were identified, with preoperative AMI strongly predicting its persistence. Joint effusion and specific meniscal lesions appear to act as preoperative triggers, whereas cartilage damage and sex may influence postoperative evolution. Early identification and management of modifiable risk factors, particularly before surgery, may help optimize rehabilitation and limit the persistence of AMI after ACLR. LEVEL OF EVIDENCE: Level III.