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Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus
British Journal of Sports Medicine ( IF 11.6 ) Pub Date : 2022-12-01 , DOI: 10.1136/bjsports-2022-105495
Adam G Culvenor 1 , Michael A Girdwood 2 , Carsten B Juhl 3, 4 , Brooke E Patterson 2 , Melissa J Haberfield 2 , Pætur M Holm 3, 5 , Alessio Bricca 3, 5 , Jackie L Whittaker 6, 7 , Ewa M Roos 3 , Kay M Crossley 2
Affiliation  

Objective Synthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes. Design Overview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. Data sources MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library. Eligibility criteria Systematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults. Results We included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured individuals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength; (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function; (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function; and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively; (2) cryotherapy reduces pain and analgesic use; (3) psychological interventions improve anxiety/fear; and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size; (2) blood flow restriction training improves quadriceps size; (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function; and (4) continuous passive motion has no effect on range of motion. Conclusion The general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.

中文翻译:

前交叉韧带和半月板损伤后的康复:OPTIKNEE 共识系统评价的最佳证据综合

目的 综合证据证明 ACL 和/或半月板撕裂后康复干预对症状、功能、临床、社会心理、生活质量和再损伤结果的有效性。系统评价的设计概述,建议分级评估、开发和评估证据的确定性。数据来源 MEDLINE、EMBASE、CINAHL、SPORTDiscus 和 Cochrane 图书馆。资格标准 对调查年轻成人 ACL 和/或半月板撕裂后康复干预的随机对照试验的系统评价。结果 我们纳入了 22 项评估 ACL 损伤个体的系统评价(142 项试验大部分为男性),但没有一项评估孤立的半月板损伤。我们综合了评估 12 种不同干预措施的 16 篇评论的数据。观察到中等质量的证据:(1)神经肌肉电刺激提高股四头肌力量;(2) 开放式与封闭式动力链练习对股四头肌力量和自我报告的功能同样有效;(3) 结构化的家庭康复与结构化的面对面康复对股四头肌和腿筋力量以及自我报告的功能同样有效;(4) 术后膝关节支撑对身体功能和松弛度无效。低质量证据表明:(1)术前运动疗法改善了术后的自我报告和身体机能;(2) 冷冻疗法减轻疼痛和止痛药的使用;(3) 心理干预改善焦虑/恐惧;(4)全身振动提高股四头肌力量。非常低质量的证据表明:(1)基于蛋白质的补充剂可以改善股四头肌的大小;(2) 血流限制训练改善股四头肌尺寸;(3) 神经肌肉控制练习提高股四头肌和腘绳肌的力量和自我报告的功能;(4) 连续被动运动对运动范围没有影响。结论 ACL 或半月板撕裂后康复的一般证据水平较低。中等质量的证据表明,几种康复类型可以提高股四头肌的力量,而支具的使用对膝关节功能/松弛度没有影响。
更新日期:2022-12-01
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