Joseph C. Brinkman M.D. , Jose M. Iturregui M.D. , M. Lane Moore B.S., M.B.A. , Jack Haglin M.D. , Adam Thompson B.S. , Justin Makovicka M.D. , Kostas J. Economopoulos M.D.
{"title":"关节镜下后关节囊松解术可改善运动员前交叉韧带重建术后的活动范围和屈曲挛缩疗效","authors":"Joseph C. Brinkman M.D. , Jose M. Iturregui M.D. , M. Lane Moore B.S., M.B.A. , Jack Haglin M.D. , Adam Thompson B.S. , Justin Makovicka M.D. , Kostas J. Economopoulos M.D.","doi":"10.1016/j.asmr.2024.100914","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction.</p></div><div><h3>Methods</h3><p>A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications.</p></div><div><h3>Results</h3><p>Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years’ follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, <em>P</em> < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (<em>P</em> < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (<em>P</em> < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension.</p></div><div><h3>Conclusions</h3><p>For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. In addition, subjects demonstrated a high rate of return to sport and return to preinjury performance levels.</p></div><div><h3>Level of Evidence</h3><p>Level IV, therapeutic case series.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000324/pdfft?md5=438acbe143f2e0ec5da2af0a53311e55&pid=1-s2.0-S2666061X24000324-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Arthroscopic Posterior Capsular Release Improves Range of Motion and Outcomes for Flexion Contracture After Anterior Cruciate Ligament Reconstruction in Athletes\",\"authors\":\"Joseph C. Brinkman M.D. , Jose M. Iturregui M.D. , M. Lane Moore B.S., M.B.A. , Jack Haglin M.D. , Adam Thompson B.S. , Justin Makovicka M.D. , Kostas J. Economopoulos M.D.\",\"doi\":\"10.1016/j.asmr.2024.100914\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction.</p></div><div><h3>Methods</h3><p>A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications.</p></div><div><h3>Results</h3><p>Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years’ follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, <em>P</em> < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (<em>P</em> < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (<em>P</em> < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension.</p></div><div><h3>Conclusions</h3><p>For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. 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引用次数: 0
摘要
Purpose To assess the outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction.Methods 对2014年1月至2019年12月期间因前交叉韧带(ACL)重建后膝关节伸展功能丧失而接受关节镜后关节囊松解术的患者进行回顾性回顾前瞻性收集的数据。手术适应症包括前交叉韧带重建术后至少 3 个月,物理治疗无效且伸展度大于 10°的患者。参加过高中或大学体育运动、有完整的相关结果且随访至少 2 年的患者均被纳入研究范围。前瞻性收集的结果包括术前和术后的膝关节伸展测量、国际膝关节文献委员会评分、Lysholm评分、恢复运动数据以及并发症。患者平均在前交叉韧带重建术后 16 周接受手术。随访两年时,膝关节伸展度平均提高了13.8°(松解前平均伸展度不足15.1°,松解后平均伸展度不足1.3°,P< .005)。国际膝关节文献委员会评分在 6 个月时平均提高了 21.7 分,在 24 个月时平均提高了 35.0 分,两者均有统计学意义(P < .001)。同样,莱斯霍尔姆评分也有显著改善,6 个月和 2 年时分别为 23.0 分和 34.2 分(P < .001)。总之,77.8%的患者在前交叉韧带初次手术后平均9.8个月恢复运动,在后关节囊松解手术后平均6.5个月恢复运动。手术中未发现感染或神经血管并发症。结论对于前交叉韧带重建术后膝关节持续伸展受限的运动员,关节镜后关节囊松解术后2年,膝关节伸展明显改善。对于前交叉韧带重建后膝关节持续伸展功能丧失的运动员,关节镜后关节囊松解术后 2 年,膝关节伸展功能明显改善,患者报告的结果也有很大改善。此外,受试者恢复运动和恢复到受伤前表现水平的比率也很高。
Arthroscopic Posterior Capsular Release Improves Range of Motion and Outcomes for Flexion Contracture After Anterior Cruciate Ligament Reconstruction in Athletes
Purpose
To assess outcomes of arthroscopic posterior capsular release among athletes for loss of terminal extension following anterior cruciate ligament (ACL) reconstruction.
Methods
A retrospective review of prospectively collected data was performed for patients undergoing arthroscopic posterior capsular release for knee extension loss following ACL reconstruction between January 2014 and December 2019. Procedure indications included extension loss greater than 10° at least 3 months after ACL reconstruction that was refractory to physical therapy. Patients were included if they were involved in either high school or college athletics, had complete outcomes of interest, and had at least 2 years of follow-up. Prospectively collected outcomes included preoperative and postoperative measurement of knee extension, International Knee Documentation Committee score, Lysholm score, return to sport data, and complications.
Results
Eighteen athletes with minimum 2 years of follow-up who underwent posterior capsular release following ACL reconstruction performed by a single surgeon were included in the analysis. Patients underwent surgery at an average of 16 weeks after ACL reconstruction. Knee extension improved an average of 13.8° at 2 years’ follow-up (prerelease mean extension deficit 15.1°, postrelease mean extension deficit 1.3°, P < .005). Improvements in the International Knee Documentation Committee score averaged 21.7 at 6 months and 35.0 at 24 months, both of which were statistically significant (P < .001). Similarly, differences in Lysholm included a significant improvement of 23.0 and 34.2 at 6 months and 2 years, respectively (P < .001). In total, 77.8% returned to sport at an average of 9.8 months from their primary ACL surgery and 6.5 months following posterior capsular release surgery. No infections or neurovascular complications were observed. One patient required secondary release to achieve adequate extension.
Conclusions
For athletes with persistent knee extension loss after ACL reconstruction, knee extension was significantly improved at 2 years following arthroscopic posterior capsular release. Substantial improvements in patient-reported outcomes also were seen. In addition, subjects demonstrated a high rate of return to sport and return to preinjury performance levels.