| ObjectiveAnterior Cruciate Ligament(ACL)injury is a common sports injury,and arthroscopic ACL reconstruction is the mainstream surgical treatment for this injury.At present,there is no gold standard for rehabilitation programs after ACL reconstruction,and there is still a lack of a unified time node for when to perform knee bending training after surgery.Bone Tunnel Enlargement(BTE)is a common complication after ACL reconstruction.It is believed that this complication is related to early postoperative rehabilitation training.The purpose of this study is to explore a more appropriate timing of knee flexion in rehabilitation after ACL surgery,which can not only meet the needs of early rehabilitation,but also greatly reduce the expansion of bone tunnels,and provide clinical references for rehabilitation after ACL reconstruction.MethodsThis is a prospective clinical study.According to the inclusion and exclusion criteria,patients with ACL injuries were treated in the Department of Joint Orthopedics,First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from June2020 to December 2020.All patients underwent arthroscopic ACL reconstruction.According to the knee meniscus injury in the actual operation,the included patients were divided into a 2-week knee flexion group and a 4-week knee flexion group.The two groups of patients were given knee flexion training at 2 weeks and 4 weeks after surgery,and take Traumatology Bone-building Tablets.The Lysholm Knee Scale(LKS)and the International Knee Documentation Committee Subjective Knee Form(IKDC)were used to score the patient’s knee joint function before and after the operation.The diameter of drill sizes used in the operation was recorded.Collect the knee joint MRI(Magnetic Resonance Imaging,MRI)of the two groups of patients 3 months after the operation,measure the diameter of the bone tunnel on the four levels of the MRI image.The diameter of the bone tunnel was compared to obtain the expansion percentage of the bone tunnel,and the tendon bone healing on MRI was observed.The differences in the bone tunnel expansion percentage,clinical score and tendon healing between the two groups before and after surgery were compared.ResultsA total of 38 patients were enrolled,and 3 patients were eliminated due to variation in the surgical method.Finally,a total of 35 patients got the final follow-up at 3 months after the operation,including 17 in the 2-week knee flexion group,18 in the 4-week knee flexion group.There was no statistically significant difference between the two groups of patients in basic data such as gender,side of injury,and average age(P >0.05)In terms of bone tunnel expansion,the percentage of tunnel expansion in the 2-week knee flexion group was greater than that in the 4-week knee flexion group.Among them,the difference in the expansion of the sagittal tibia was statistically significant(26.51±8.84 VS 15.05±4.98,P <0.05),and the difference in the expansion of the tibial coronal position was also statistically significant(22.64 ±9.80 VS 12.07±3.63,P <0.05),the percentage of bone tunnel enlargement in the femoral horizontal position was not statistically significant(15.12±3.76 VS 9.60±4.08,P >0.05),and the expansion of the femoral coronal position was statistically significant(15.44±6.76 VS 11.05±3.98,P <0.05).In terms of clinical scores,the Lysholm scores and IKDC subjective scores of the two groups of patients at the last follow-up were significantly improved compared with those before the operation(P<0.05).At the last follow-up,the difference in Lysholm score between the two groups was not statistically significant(91.12±2.71 V.S 90.56±2.23,P >0.05),the subjective IKDC score of the 2-week knee flexing group was higher than that of the 4-week group,and the difference was statistically significant(63.29±1.86 V.S62.06±1.59,P <0.05).In terms of graft healing,8 cases were grade Ⅰ(47.1%),7 cases were grade Ⅱ(41.2%),and 2 cases were gradeⅢ(11.7%)in the 2-week knee flexion group.In the 4-week knee flexion group,12 cases were gradeⅠ(66.7%),6 cases were gradeⅡ(33.3%),and 0 cases were grade Ⅲ(0%).There was no statistically significant difference between the two groups(P >0.05).ConclusionsRehabilitation and ligament revision will become the research focus of ACL reconstruction in the future.Different knee flexion time nodes have little effect on functional recovery after anterior cruciate ligament reconstruction,but knee flexion activities in the early postoperative period will have a negative impact on the expansion of the bone tunnel.On the premise of ensuring functional rehabilitation,a relatively mild rehabilitation program can be considered to reduce bone The tunnel expansion occurred.Different knee flexion time nodes have little effect on functional recovery after ACL reconstruction,and knee flexion rehabilitation exercises in the early stage(2 weeks)after ACL surgery will expand BTE.Therefore,on the premise of ensuring functional rehabilitation,a relatively mild(4 weeks)rehabilitation program can be considered to reduce the occurrence of BTE. |
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