Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Strategies for optimal rehabilitation after anterior cruciate ligament (ACL) reconstruction (ACLR) continue to evolve, as the incidence of contralateral ACL injuries and ACL failures varies widely in the literature, highlighting the need for optimising rehabilitation protocols. Early and intermediate rehabilitation build the crucial foundation on which later stages of rehabilitation can successfully be based, ideally leading to satisfactory outcomes and return to preinjury sports performance. However, guidelines for optimal pre- and postoperative rehabilitation management following ACLR remain conflicting, complicating evidence-based decision-making for rehabilitation following ACLR in clinical practice. Furthermore, a standardised rehabilitation protocol, adopted across different institutions, could enable more reliable comparisons of outcomes across studies focusing on surgical aspects, such as graft selection and fixation methods. An international, multidisciplinary group of experts was convened at the 2024 Freddie Fu Panther Sports Medicine Symposium to discuss and debate recent advances and future directions of rehabilitation and return to sport following ACLR. While this part of the series explores the preoperative and early to intermediate phases of rehabilitation, Part 2 highlights the complexity of return to sport and adjunct technologies after ACLR. Early recovery of knee extension, quadriceps function and early focus on movement quality are key components for achieving satisfactory outcomes after ACLR. This summary of key concepts aims to give an overview of recent evidence and current concepts of early and intermediate rehabilitation after ACLR from a multidisciplinary expert perspective and how it needs to be tailored to the individual based on graft type and patient demographics in clinical practice.

Level of Evidence

Level IV, expert opinion.

Anterior cruciate ligament reconstruction is frequently performed to allow athletes to return to their pre-injury levels of sports participation. A relatively low proportion of athletes successfully achieving this goal, and high rates of secondary injuries after clearance for return to sport highlight the need for optimised rehabilitation and return to sports protocols. A lack of evidence and general consensus on optimal return to sport milestones has caused substantial variability across currently applied concepts, emphasising the need for interdisciplinary approaches to bridge the gap between research findings and clinical application. This summary of key concepts aims to provide a comprehensive framework for optimising return to sport outcomes following anterior cruciate ligament reconstruction in athletes from a multidisciplinary expert perspective. An international, multidisciplinary group of experts was convened at the 2024 Freddie Fu Panther Sports Medicine Symposium to discuss and debate recent advances, future directions and emerging technological innovations of rehabilitation and return to sport following anterior cruciate ligament reconstruction. While Part 1 addressed recent evidence and strategies for early and intermediate phases of rehabilitation after anterior cruciate ligament reconstruction, Part 2 of this series explores the complexity of return to sport conceptualised as a continuum by evaluating key aspects such as functional testing, psychological readiness, and prevention of re-injury while also discussing emerging technologies that promise to enhance the future of rehabilitation and return to sports after anterior cruciate ligament reconstruction.

Level of Evidence

Level IV, expert opinion.

Purpose

To understand the changes in muscle force control ability and its association to gait biomechanics following anterior cruciate ligament reconstruction (ACLR).

Methods

Twenty-five participants, 9 months following ACLR, performed isometric quadriceps (20%, 40% and 100% maximum voluntary isometric contraction [MVIC]) and hamstring (20% and 40% MVIC) contractions on an isokinetic dynamometer, tracing a target line. Torque variability using coefficient of variation, and complexity using sample entropy were calculated. Knee moments and knee flexion excursion were calculated from walking gait. Two-way mixed model analyses of variance were used for between-limb comparisons and Pearson's correlations to evaluate the associations between force variables and gait biomechanics.

Results

Quadriceps and hamstring torque variability changed depending on the limb and the effort level. Quadriceps variability was higher in the ACLR limb only at maximum effort (p = 0.039, Cohen's d = 0.437). Hamstring variability showed no differences at 40% but lower torque variability (p = 0.035, Cohen's d = −0.448) at 20%. Muscle force complexity was consistently higher in the ACLR limb compared to the noninjured limb, regardless of effort level. Additionally, as effort increased, muscle force became less complex in both limbs.

Quadriceps variability was negatively associated with knee moments (r = −0.410, p = 0.042, better force control = higher knee extension moments). Hamstring complexity was positively associated with knee flexion excursion (r = 0.417, p = 0.038). Maximal strength was not associated with any gait biomechanics.

Conclusions

Quadriceps and hamstring force control ability are altered and associated with gait biomechanics at 9 months post-ACLR. Rehabilitation should include exercises focused on force control to potentially help restore gait biomechanics.

Level of Evidence

Level IV.

Purpose

The aim of this systematic review was to analyze the implementation of digital rehabilitation in the rehabilitation of patients undergoing anterior cruciate ligament reconstruction (ACLR).

Methods

A systematic literature research was carried out on multiple platforms. Articles that fit our criteria were selected and analysed. We created a narrative synthesis of the extracted data, categorised by the type of digital application (sensor or no sensor), clinical characteristics and type of outcome. A formal meta-analysis was not planned as the studies were probably not homogeneous enough in terms of participants, interventions and outcomes to provide a meaningful summary.

Results

This systematic review analysed seven articles with 952 patients studying digital applications in rehabilitation⁠ after ACLR. Seven different digital applications were investigated, with three using sensors. The results showed that digital interventions were at least as effective as standard physiotherapy, with some studies showing even better outcomes in terms of Patient-Reported Outcome Measures (PROMs), muscle strength, and range of motion⁠. Patient engagement and better adherence to the rehabilitation plan was another positive finding. Importantly, no adverse events were reported in any of the studies⁠.

Conclusion

This systematic review highlights the potential of digital applications as valuable tools for rehabilitation after ACL reconstruction by enhancing patient adherence, engagement, and recovery outcomes.

Level of Evidence

N/A.

Purpose

Anterior cruciate ligament reconstruction (ACLR) is among the most performed orthopaedic procedures. Evaluating the effect of smoking on postoperative outcomes following ACLR could benefit many patients. This study investigated the impact of smoking on graft failure and functional outcomes following ACLR.

Methods

PubMed, MEDLINE, and Embase were searched up until March 9, 2025. The primary outcome was ACL graft failure after ACLR. Inclusion criteria were: age ≥18 years, ≥1-month follow-up (FU), ACL reconstruction, and articles in English. Exclusion criteria were: cadaveric studies, ACL repair, ≤5 participants, reviews, and case reports. Meta-analysis results were reported as odds ratios (ORs) and proportions with 95% confidence intervals (CIs).

Results

A total of 12 studies were included (92,208 patients) (mean FU: 42.8 ± 17.0 months; mean age: 35.9 ± 6 years; 6.8% smokers; 57.9% male). The quality of included studies was moderate, (MINORS score range: 9 to 21). In smoker's reoperation rate was 7.6% (FU 59.4 months). For non-smokers the reoperation rate was 5.2% (59.9 months FU). Three studies (2,823 patients) compared ACL graft failure rates, with similar pooled failure rates of 5.0% and 5.5% in smokers and non-smokers, respectively (OR 1.12 [95% CI: 0.38–3.29]). Four studies (1285 patients) compared postoperative IKDC scores with mean scores of 79.6 ± 10.3 in smokers and 84.0 ± 9.5 in non-smokers, respectively (OR 5.12 [95% CI: 3.59–6.65]). One study reported Tegner scores that were not different between smokers (5.0) and non-smokers (5.4).

Conclusion

This systematic review demonstrated that ACL graft failure and all-cause reoperation rates did not differ significantly between smokers and non-smokers. Nonetheless, non-smokers were significantly more likely to achieve superior functional outcomes following ACL reconstruction.

Level of Evidence

Level IV.

Purpose

To evaluate the effectiveness of digital health technology (DHT) in postoperative rehabilitation following anterior cruciate ligament reconstruction (ACLR) and to explore intervention characteristics influencing outcomes.

Methods

Seven databases (PubMed, Web of Science, Embase, Cochrane Library, SinoMed, CNKI and Wan Fang) were searched from inception to 15 March 2025 for randomized controlled trials on DHT (e.g., wearable devices, virtual reality, robotics) for ACLR rehabilitation. Outcomes included rehabilitation adherence, knee function, proprioception, muscle strength, walking ability and pain. Meta-analysis using a random effects model was conducted to determine the standardized mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs).

Results

This review included 16 RCTs with a total of 1064 ACLR patients. The meta-analysis results indicated that DHT improved rehabilitation adherence (SMD = 0.29, 95% CI = 0.02–0.56, p = 0.04), pain (SMD = −0.79, 95% CI = −1.38 to −0.19, p = 0.009), proprioception (MD = −0.99, 95% CI = −1.47 to −0.50, p < 0.0001), muscle strength (extensor peak torque: MD = 11.43, 95% CI = 6.26–16.61, p < 0.0001; flexor peak torque: MD = 12.03, 95% CI = 6.54–17.52, p < 0.0001) and walking ability (MD = 0.41, 95% CI = 0.32–0.49, p < 0.00001). Subgroup analyses indicated that virtual reality-based DHT improved knee function (MD = 3.88, 95% CI = 0.95–6.81, p = 0.010). Short-term interventions (<3 months) showed greater efficacy in functional recovery (MD = 3.57, 95% CI = 0.93–6.20, p = 0.008).

Conclusion

DHT is a feasible and effective approach for post-ACLR rehabilitation. Our findings demonstrate that DHT enhances adherence, improves knee function and alleviates pain, and restores muscle strength, proprioception and walking ability. These results support the integration of DHT into standardized rehabilitation protocols for ACLR patients.

Level of Evidence

Level IV.

Purpose

This review systematically maps the existing research on objective return to sport criteria for shoulder injuries, with a focus on clinical tests that inform decision-making.

Methods

A scoping review was performed. The following databases were searched from inception up to July 2025: Cochrane Library, Embase, Medline, PEDRo, Cinahl and AMED. All studies, regardless of design, which assessed any kind of shoulder function with regard to return to sport decision-making in individuals participating in sports and presented with a shoulder injury were included. The result was qualitatively presented in free text, tables and figures.

Results

Eleven studies were identified that reported objective shoulder tests prior to return to sport in athletes after shoulder instability surgery. The tests evaluated various parameters, including range of motion, muscular strength, muscular endurance, power, plyometrics, movement quality and trunk control. The passing rates of isokinetic shoulder strength tests ranged from 40% to 70%, the isometric shoulder strength tests from 28% to 100%, for shoulder endurance tests from 70% to 81% and shoulder performance tests from 29% to 100%. These assessments were conducted within a time frame of 4–21 months following surgery. The rate of subsequent shoulder instability or re-dislocation ranged from 5% to 10% after returning to sport.

Conclusions

Passing rates for objective shoulder tests, including muscular strength and endurance, as well as performance tests, varied widely, with re-dislocation rates between 5% and 10% after returning to sport. However, the predominance of case series limits the ability to draw definitive conclusions about the effectiveness of these tests in reducing the risk of subsequent shoulder instability.

Level of Evidence

Level IV, scoping review of level III.