前交叉韧带重建后持续性膝关节问题年轻成人的运动疗法与教育：一项随机临床试验
简介
这项RCT纳入184例ACL重建后9~36个月仍有持续膝问题的年轻成人（18~40岁），比较物理治疗师监督下每周2次、为期4个月的运动疗法+教育（SUPER）与单次教育+自主运动资源的效果。4个月时SUPER组KOOS4复合评分改善优于对照组（14.1 vs 9.4，调整均差4.8），肌力增益和整体变化成功率更高，但12个月时组间差异因对照组继续改善而缩小，…
英文摘要
BACKGROUND: Chronic knee symptoms and early-onset osteoarthritis are common after anterior cruciate ligament reconstruction (ACLR). Evidence to inform management is needed. OBJECTIVE: To evaluate whether physiotherapist-supervised exercise therapy with education is superior to a single education session and self-directed exercise resource for young adults with persistent knee problems after ACLR. DESIGN: Parallel-group randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12620001164987). SETTING: Community. PARTICIPANTS: 184 young adults (aged 18 to 40 years) with persistent knee problems 9 to 36 months after ACLR. INTERVENTION: A 4-month twice-weekly physiotherapist-supervised exercise therapy program with education (SUPER [SUpervised exercise-therapy and Patient Education Rehabilitation]; n = 92) and a single physiotherapist-delivered education session and self-directed exercise resource (control; n = 92). MEASUREMENTS: Primary outcome was 4-month change in the composite Knee injury and Osteoarthritis Outcome Score (KOOS4; 0= worst, 100= best). Secondary outcomes included KOOS4 at 12 months and thigh muscle strength, patient-perceived global rating of change, and cartilage thickness and composition on magnetic resonance imaging at 4 and 12 months. RESULTS: 184 participants were randomly assigned (mean age, 30 years [SD, 6]; 2.2 years [SD, 0.7] after ACLR); 178 (97%) and 174 (95%) completed 4-month and 12-month follow-up, respectively. At 4 months, KOOS4 scores improved more in the SUPER group than in the control group (14.1 vs. 9.4; adjusted mean difference, 4.8 [95% CI, 1.4 to 8.2]). At 4 months, SUPER resulted in greater muscle strength gains and higher rates of success on global rating of change (for example, pain 73% vs. 40%). Between-group differences narrowed at 12 months as the control group continued to improve, whereas SUPER gains were sustained. There were no between-group differences seen in cartilage thickness or composition. LIMITATION: Unblinded participants. CONCLUSION: For young adults with persistent knee problems after ACLR, physiotherapist-supervised exercise therapy with education improved patient-reported outcomes compared with a single education session and self-directed exercise resource, but these between-group differences may not be sustained over time. PRIMARY FUNDING SOURCE: National Health and Medical Research Council.