前交叉韧带重建术后康复期及重返运动时的神经适应性差异：系统综述与荟萃分析
简介
一项关于ACL重建术后康复期（≤12个月）与重返运动期（≥12个月）神经适应变化的系统综述和meta分析显示，与健康对照相比，ACL重建患者两侧大脑皮质脊髓对股四头肌的控制均存在适应不良，且重返运动时手术侧大脑皮质及脊髓兴奋性改变仍未恢复，并与股四头肌力量及中枢激活比率相关。这提示康复方案及重返运动评估中应纳入双侧神经生理学干预与监测手段。
英文摘要
BACKGROUND: Individuals with anterior cruciate ligament reconstruction (ACLR) demonstrated neurological adaptations, but it remains unclear how these changes evolve from rehabilitation to return to sport (RTS) and how they affect quadriceps neuromuscular weakness. Therefore, this review aims to: (a) compare the activation in the cerebral cortex as well as the corticospinal and spinal tract of quadriceps between individuals with ACLR and healthy controls; (b) determine the effects of the neurological alterations on quadriceps neuromuscular function during rehabilitation and RTS. METHODS: A systematic search was conducted across PubMed, Web of Science, Medline, and SPORTDiscus. Risk of bias was assessed by the Methodological Index for Non-randomized Studies checklist and Egger's test. The evidence certainty was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Participant characteristics, time of data collection, the stage of rehabilitation (<12 months post-ACLR) or RTS (≥12 months post-ACLR), data on neurological measures (cortical activation, corticospinal and spinal excitability), data on quadriceps neuromuscular function (strength, rate of torque development (RTD), central activation ratio (CAR)), and relevant results in individual studies were extracted and synthesized in a narrative or quantitative format. RESULTS: Twenty studies involving 504 individuals with ACLR and 362 healthy controls were included, with certainty levels rated low to very low. Compared to healthy controls, individuals with ACLR exhibited increased active/resting motor threshold (AMT/RMT) in the nonsurgical limb only (standardized mean difference (SMD) = 0.64, p = 0.009), comparable interval intracortical facilitation and short interval intracortical inhibition, bilateral increased motor evoked potential (MEP) amplitudes (surgical: SMD = 0.71, p = 0.02; nonsurgical: SMD = 0.32, p = 0.03), and comparable H-reflex/M-wave ratio (H/M ratio), with the MEP amplitudes negatively associated with quadriceps strength during rehabilitation. At RTS, individuals with ACLR presented greater activation in frontal and parietal regions in the brain cortex contralateral to the surgical limb during knee flexion/extension movements, increased AMT/RMT (SMD = 0.73, p = 0.003) and H/M ratio (SMD = 0.33, p = 0.0009) in the surgical limb, with a negative association between AMT/RMT and quadriceps CAR. CONCLUSION: Individuals with ACLR demonstrate bilateral corticospinal maladaptations in the quadriceps during rehabilitation (<12 months post-ACLR), and the alterations in the cortical, corticospinal, and spinal excitability in the surgical limb remain unresolved at the time of RTS (≥12 months post-ACLR). These neurological alterations are associated with quadriceps neuromuscular function, which underscores the importance of incorporating bilateral neurophysiological interventions and assessments into rehabilitation protocols and RTS criteria to improve the outcomes of ACLR.