前交叉韧带重建术后肌肉萎缩的减轻
简介
这篇基于系统文献检索的综述总结了减少前交叉韧带（ACL）重建后肌肉萎缩的多模式围手术期策略。关键发现包括：术前手术时机（伤后21–100天）和结构化预康复至关重要；术中应避免股神经阻滞，且移植物选择影响显著（股四头肌腱萎缩风险最高，腘绳肌腱最低）；术后渐进性离心训练和早期神经肌肉电刺激（NMES）最有效，同时优化营养（≥1.6–1.9 g/kg/天蛋白质）及…
英文摘要
BACKGROUND: Thigh muscle atrophy is a consistently reported complication following anterior cruciate ligament (ACL) reconstruction. Poor postoperative muscle status is associated with inferior functional outcomes and an increased risk of re-injury. METHODS: This narrative review is based on a systematic literature search in PubMed and Cochrane investigating pre-, intra-/perioperative, and postoperative interventions, as well as adjunctive measures (nutrition, supplementation) aimed at reducing muscle atrophy following ACL reconstruction. RESULTS: Several factors and interventions can reduce post-reconstruction muscle atrophy. Preoperatively, the timing of surgery (21-100 days after injury) and structured prehabilitation are essential. Intraoperatively, tourniquet use increases early postoperative atrophy without affecting long-term outcomes; femoral nerve block should be avoided. Graft choice has a substantial impact on the risk of muscle atrophy (quadriceps tendon > patellar tendon > hamstring tendon). Postoperatively, progressive eccentric resistance training and early neuromuscular electrical stimulation (NMES) are most effective interventions, while blood flow restriction training (BFRT) is a promising adjunctive strategy. Nutritional optimization (≥ 1.6-1.9 g protein/kg/day) and perioperative supplementation with essential amino acids (EAAs) and β-hydroxy-β-methylbutyrate (HMB) have demonstrated beneficial effects, particularly in high-risk patients. CONCLUSION: Muscle atrophy following ACL reconstruction is unavoidable but can be substantially reduced through a multimodal perioperative approach. In particular, high-risk patients are likely to benefit from the consistent combination of all available preventive strategies.