前交叉韧带重建术后不同抗阻训练方式的比较效果：随机对照试验的网络荟萃分析
简介
基于22项随机对照试验的网络荟萃分析比较了ACLR术后不同抗阻训练模式的效果。结果显示，血流限制训练在恢复股四头肌肌力和肌量方面优于常规多模式康复，等速训练在改善膝关节功能上排名最高但未证实优于其他主动训练，离心训练则可能提升生活质量。临床可按康复目标个体化选择抗阻训练方式。
英文摘要
BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), resistance training is essential, yet the comparative effectiveness of specific approaches remains uncertain. The objective was to compare the effectiveness of commonly used resistance training modalities after ACLR on quadriceps strength, quadriceps mass, knee function, and health-related quality of life (QoL). METHODS: PubMed, Embase, Cochrane CENTRAL, Web of Science, and Google Scholar were searched to 30 September 2025 for randomized controlled trials in adults or adolescents after primary ACLR. Eligible studies compared modality-dominant resistance-based rehabilitation with standard multimodal postoperative rehabilitation or other resistance approaches and reported quadriceps strength, quadriceps mass, knee function, or QoL. The standard multimodal rehabilitation comparator was interpreted as usual rehabilitation practice rather than absence of exercise or resistance training. A random-effects network meta-analysis estimated standardized mean differences (SMDs) with 95% confidence intervals and ranked treatments using surface under the cumulative ranking curve (SUCRA). RESULTS: Twenty-two trials (n = 797) were included. For quadriceps strength, blood flow restriction training (BFRT) ranked first (SUCRA 81.7) and exceeded standard multimodal rehabilitation (CON) (SMD 0.40; 95% CI 0.07 to 0.73). For quadriceps mass, BFRT ranked first (SUCRA 79.1) and exceeded CON (SMD 0.82; 95% CI 0.11 to 1.53). For knee function, isokinetic training (IKT) had the highest-ranking probability (SUCRA 87.7), but pairwise differences among active modalities were not statistically significant, indicating no clear evidence of clinical superiority. For QoL, eccentric training (ET) ranked first (SUCRA 87.4) and improved QoL versus CON (SMD 1.31; 95% CI 0.01 to 2.63). CONCLUSION: Post-ACLR resistance prescription should be outcome-oriented. BFRT may be considered when the primary target is recovery of quadriceps strength and mass, particularly compared with usual standard multimodal rehabilitation. IKT may be considered when aiming to improve knee function, but current evidence does not confirm its superiority over other active modalities. ET may be considered when improving QoL is a major rehabilitation goal, although this finding should be interpreted cautiously given the limited certainty of evidence. These findings should be understood as comparisons between modality-dominant programs and standard multimodal rehabilitation, and may help inform individualized rehabilitation planning following ACLR. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251182456.