前交叉韧带重建术后股四头肌自主激活缺陷不随肌力增加而改善：一项基于时间趋势的荟萃回归分析系统综述
简介
一项纳入50项研究（1772例患者）的系统综述与meta回归分析发现，ACLR术后股四头肌力量随时间呈非线性改善（69个月时达2.63 Nm/kg），但自主激活（VA）缺陷并无显著恢复（每月仅改善0.03%）。该结果提示，即使力量对称性达标，神经激活障碍可能依然存在，单纯以力量恢复作为重返运动标准可能高估神经肌肉功能恢复。
英文摘要
BACKGROUND: Quadriceps weakness is common following anterior cruciate ligament reconstruction (ACLR). Voluntary activation (VA) deficits may contribute to persistent weakness, but their recovery trajectory remains unclear. This systematic review examined temporal changes in quadriceps strength and VA following ACLR. METHODS: Six databases and 2 clinical trial registries were searched to March 2025. Studies reporting quadriceps strength and VA following ACLR were included. Random-effects meta-analyses and meta-regression examined temporal trends. Risk of bias was assessed using JBI tools and certainty of evidence using GRADE. RESULTS: Fifty studies (1772 participants; 91 effect sizes) were included. Three-level meta-regression demonstrated that VA showed no significant improvement over time (0.03% per month, 95% confidence interval (95%CI): -0.25% to 0.29%; mean = 86.8%, 95%CI: 83.9%-89.8%, p = 0.876). Quadriceps strength improved nonlinearly (Q = 31.53, p < 0.001), reaching 2.63 Nm/kg (95%CI: 2.00-3.27) by 69 months. Participant age (p = 0.60), sex (p = 0.50), assessment position (p = 0.44), graft type (p = 0.32) or primary versus secondary reconstruction (p = 0.56) did not moderate VA. Studies that measured VA with the central activation ratio overestimated VA compared to the interpolated twitch technique by 6.5% (95%CI: 2.4%-10.6%, p = 0.002). Evidence certainty was rated as very low. CONCLUSION: Following typical rehabilitation, quadriceps strength improved over time, whereas VA showed no detectable recovery. Strength recovery may therefore occur despite ongoing impairments in neural activation, suggesting strength symmetry alone may overestimate neuromuscular recovery. Given the very low certainty of evidence, these findings should be interpreted cautiously.