Objective To investigate the effects of rotation stability after anterior cruciate ligament reconstruction (ACLR) on subjective outcomes,sport performance,psychological readiness,and return to sport. Methods The patients who underwent ACLR in the Sports Hospital,National Institute of Sports Medicine,General Administration of Sport of China from January 2015 to January 2021 were followed up during the period from November 2022 to December 2023.The patients were grouped according to the results of the pivot shift test (PST) of the affected knee at the last follow-up visit.A total of 66 patients who participated in the follow-up and met the inclusion and exclusion criteria were finally enrolled in this study,including 32 patients showing a negative PST result (stable group) and 34 patients showing a positive PST result (unstable group).The basic information,subjective function score,and return-to-sport performance were compared between the two groups. Results In terms of sport performance,the two groups showed differences in the limb symmetry index in single-leg hops,triple hops,and crossover hops (P=0.028,P=0.024,and P=0.044,respectively).The anterior cruciate ligament-return to sport after injury scale score was higher in the stable group than in the unstable group [(70.44±22.82) scores vs. (53.44±21.74) scores,P=0.003].The mean of KT-2000 test results in the stable group was lower than that in the unstable group [(0.53±1.02) mm vs. (2.06±2.31) mm,P=0.001].The Lysholm score,international knee documentation committee score,knee injury and osteoarthritis outcome score,Tegner score,and Marx score did not have significance between the two groups (all P>0.05).The return-to-sport rate was 43.8% (including 14.3% reaching safe return criteria,which accounted for 6.3% in all the patients) in the stable group and 35.3% (including 8.3% reaching safe return criteria,which accounted for 2.9% in all the patients) in the unstable group.There was no difference in the 60°/s isokinetic muscle strength,maximal muscle strength ratio of the affected extensor-flexor muscles,or Y-balance test result between the two groups (all P>0.05). Conclusions Knee joint rotational instability after ACLR results in poor performance in single-leg hops,triple hops,and crossover hops,low psychological readiness,and anterior-posterior knee laxity.In short- to medium-term follow-up for ACLR,the return-to-sport rate remained low regardless of knee joint rotational stability,with the majority of patients failing to meet safe return criteria.
目的 探讨前交叉韧带重建(ACLR)术后旋转稳定性对主观结局、运动表现、心理状态及重返运动的影响。方法 于2022年11月至2023年12月对2015年11月至2021年11月在国家体育总局运动医学研究所体育医院行ACLR术的患者进行集中随访,根据最后一次随访中术侧膝关节轴移试验(PST)结果进行分组。最终纳入66例参与随访并符合纳排标准的患者,其中32例表现为PST阴性,组成稳定组;34例表现为PST阳性,组成不稳定组。比较两组患者的基本资料、主观功能评分以及重返运动表现的差异。结果 两组患者在运动表现方面,单脚跳(P=0.028)、三连跳(P=0.024)和交叉跳(P=0.044)肢体对称指数差异均有统计学意义。此外,稳定组的前交叉韧带伤后重返运动心理评分[(70.44±22.82)分]显著高于不稳定组[(53.44±21.74)分](P=0.003)。稳定组健侧与患侧的KT-2000测试差值[(0.53±1.02)mm)]显著小于不稳定组[(2.06±2.31) mm](P=0.001)。而Lysholm、国际膝关节评分委员会评估表、膝关节损伤与骨关节炎评分、Tegner和Marx评分两组比较差异均无统计学意义(P均>0.05)。稳定组重返运动率为43.8%,其中达到安全重返标准的患者占14.3%,占所有患者的比例为6.3%;而不稳定组重返运动率为35.3%,其中达到安全重返标准的患者占8.3%,占所有患者的比例为2.9%。两组60°/s等速肌力、患侧伸屈肌最大肌力比值、Y平衡测试结果差异均无统计学意义(P均>0.05)。结论 ACLR术后膝关节旋转不稳定会造成较差的单脚跳、三连跳及交叉跳的运动表现,更低的心理准备和更多的膝关节前后向松弛。在ACLR中短期随访中,无论膝关节旋转稳定性如何,重返运动率仍然较低,大部分人未达到安全重返运动标准。.
Keywords: anterior cruciate ligament reconstruction; return to sport; rotational instability; sport performance.