Efficacy of exercise therapy on recovery of moto function after anterior cruciate ligament reconstruction: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Shunchang ¹ , FU Lan ² , GUO Xiaochuan ³ , MENG Tiantian ⁴ , ZHANG Shaojun ⁵ ,  WANG Pu ⁶

1. Sports Medicine and Health Institute, Chengdu Sport University, Chengdu, 610041, P.R.China;
2. Science City Hospital, Mianyang, 621000, P.R.China;
3. Chengdu No.3 Hospital, Chengdu, 610000, P.R.China;
4. Xi’an No.4 Hospital, Xi’an, 710000, P.R.China;
5. Mianzhu Hospital, West China Hospital, Sichuan University, Mianzhu, 618200, P.R.China;
6. Medical College of Shanghai Jiaotong University, Ruijin Hospital, Shanghai, 200030, P.R.China;

Corresponding?author：

WANG Pu, Email: wangpu0816@qq.com

Keywords：

Exercise therapy; Anterior cruciate ligament reconstruction; Recovery of function; Systematic review; Meta-analysis; Randomized control trail

DOI：

10.7507/1672-2531.201902049

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Objectives To systematically review the efficacy of exercise therapy on functional and activity recovery after anterior cruciate ligament reconstruction (ACL).Methods PubMed, EMbase, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of exercise therapy on functional and activity recovery after ACL from inception to May 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 11 RCTs involving 602 patients were included. The results of meta-analysis showed that: 1 week (MD=3.07, 95%CI 1.37 to 4.77, P=0.000 4) and 3 weeks (MD=4.53, 95%CI 2.34 to 6.71, P<0.000 1) conventional exercise training rehabilitation effects were better than natural recovery under orthopedic routine care in promoting knee joint function recovery. The recovery effects of over 6 months neuromuscular training was significantly increased compared with conventional rehabilitation (MD=11.48, 95%CI 8.25 to 14.71, P<0.000 01). In addition, there was significant difference between open and closed chain exercise rehabilitation after more than 6 months rehabilitation training (MD=6.77, 95%CI 0.86 to 12.68, P=0.02).Conclusions The current evidence shows that over 6 months neuromuscular training significantly enhance the recovery of motor function after anterior cruciate ligament reconstruction. According to different reconstruction methods, individualized rehabilitation program is developed to maximize the recovery of knee joint function. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.

Citation： LI Shunchang, FU Lan, GUO Xiaochuan, MENG Tiantian, ZHANG Shaojun, WANG Pu. Efficacy of exercise therapy on recovery of moto function after anterior cruciate ligament reconstruction: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(9): 1086-1092. doi: 10.7507/1672-2531.201902049 Copy

1.	Prodromos CC, Han Y, Rogowski J, et al. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy, 2007, 23(12): 1320-1325.
2.	Shimokochi Y, Shultz SJ. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train, 2008, 43(4): 396-408.
3.	徐雁, 敖英芳. 前十字韌帶斷裂繼發半月板損害的臨床研究. 中華骨科雜志, 2002, 22(4): 216-219.
4.	Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med, 2011, 45(7): 596-606.
5.	敬沛嘉, 王謙, 李箭. 系統康復訓練對運動愛好者前交叉韌帶重建術后運動功能恢復的臨床療效. 華西醫學, 2018, 33(9): 1134-1137.
6.	黃超, 吳聽, 趙克佳, 等. 系統化康復訓練路徑在前交叉韌帶重建后膝關節本體感覺功能訓練中的應用效果. 護理實踐與研究, 2018, 15(21): 153-155.
7.	American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc, 1998, 30: 975-991.
8.	陳柯, 張杰敏, 張馨梅, 等. 階段性系統康復鍛煉在膝關節前交叉韌帶損傷重建術后的應用效果. 西部醫學, 2016, 28(4): 560-563.
9.	王海霞, 陳捷, 程小蕓, 等. 康復訓練在關節鏡下前交叉韌帶重建術患者功能恢復中的應用研究. 護理實踐與研究, 2015, 12(12): 149-150.
10.	張曉輝, 廖八根, 陳速, 等. 神經肌肉訓練對運動員前交叉韌帶重建術后康復的影響. 中國運動醫學雜志, 2014, 33(8): 772-776.
11.	Gerber JP, Marcus RL, Dibble LE, et al. Effects of early progressive eccentric exercise on muscle size and function after anterior cruciate ligament reconstruction: a 1-year follow-up study of a randomized clinical trial. Phys Ther, 2009, 89(1): 51-59.
12.	楊偉毅, 練文興, 曹學偉, 等. 肌力強化訓練對膝關節前交叉韌帶重建術后伴股四頭肌萎縮患者肌力恢復的療效. 實用醫學雜志, 2012, 28(13): 2221-2223.
13.	Morrissey MC, Drechsler WI, Morrissey D, et al. Effects of distally fixated versus nondistally fixated leg extensor resistance training on knee pain in the early period after anterior cruciate ligament reconstruction. Phys Ther, 2002, 82(1): 35-43.
14.	Perry MC, Morrissey MC, King JB, et al. Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2005, 13(5): 357-369.
15.	Chao WC, Shih JC, Chen KC, et al. The effect of functional movement training after anterior cruciate ligament reconstruction: a randomized controlled trial. J Sport Rehabil, 2018, 27(6): 541-545.
16.	單萍, 肖海濤. 本體感覺訓練在關節鏡下前交叉韌帶重建術后患者中的應用研究. 臨床與病理雜志, 2016, 36(1): 1-6.
17.	MehMet U, Koca I, Eroglu M, et al. Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction. J Phys Ther Sci, 2014, 26(12): 1875-1878.
18.	熊道海, 李玥瑩, 張云. 前交叉韌帶重建術后康復治療中開鏈與閉鏈運動的效果觀察. 南京醫科大學學報(自然科學版), 2013, 33(7): 994-998.
19.	Baumgart C, Schubert M, Hoppe MW, et al. Do ground reaction forces during unilateral and bilateral movements exhibit compensation strategies following ACL reconstruction? Knee Surg Sports Traumatol Arthrosc, 2017, 25(5): 1385-1394.
20.	Akbari A, Ghiasi F, Mir M, et al. The effects of balance training on static and dynamic postural stability indices after acute ACL reconstruction. Glob J Health Sci, 2015, 8(4): 68-81.
21.	楊靜宜. 對運動療法分類和專用術語的意見和建議. 中國康復醫學雜志, 2005, 20(5): 371-373.
22.	張國寧, 王友. 膝關節評分標準的評估. 中華外科雜志, 2006, 44(16): 1141-1143.
23.	鮑瑞林. 膝關節交叉韌帶重建手術前后lysholm膝關節活動評分比較. 寧夏醫科大學學報, 2013, 35(12): 1410-1413.
24.	Jewiss D, Ostman C, Smart N. Open versus closed kinetic chain exercises following an anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Sports Med, 2017, 2: 1-10.
25.	Daniel J, Cecilia O, Neil S. Open versus closed kinetic chain exercises following an anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Sports Med (Hindawi Publ Corp), 2017, 2017: 4721548.
26.	Perriman A, Leahy E, Semciw AI. The effect of open vs closed kinetic chain exercises on anterior tibial laxity, strength, and function following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Orthop Sport Phys, 2018, 48(7): 1-52.

1. Prodromos CC, Han Y, Rogowski J, et al. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy, 2007, 23(12): 1320-1325.
2. Shimokochi Y, Shultz SJ. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train, 2008, 43(4): 396-408.
3. 徐雁, 敖英芳. 前十字韌帶斷裂繼發半月板損害的臨床研究. 中華骨科雜志, 2002, 22(4): 216-219.
4. Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med, 2011, 45(7): 596-606.
5. 敬沛嘉, 王謙, 李箭. 系統康復訓練對運動愛好者前交叉韌帶重建術后運動功能恢復的臨床療效. 華西醫學, 2018, 33(9): 1134-1137.
6. 黃超, 吳聽, 趙克佳, 等. 系統化康復訓練路徑在前交叉韌帶重建后膝關節本體感覺功能訓練中的應用效果. 護理實踐與研究, 2018, 15(21): 153-155.
7. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc, 1998, 30: 975-991.
8. 陳柯, 張杰敏, 張馨梅, 等. 階段性系統康復鍛煉在膝關節前交叉韌帶損傷重建術后的應用效果. 西部醫學, 2016, 28(4): 560-563.
9. 王海霞, 陳捷, 程小蕓, 等. 康復訓練在關節鏡下前交叉韌帶重建術患者功能恢復中的應用研究. 護理實踐與研究, 2015, 12(12): 149-150.
10. 張曉輝, 廖八根, 陳速, 等. 神經肌肉訓練對運動員前交叉韌帶重建術后康復的影響. 中國運動醫學雜志, 2014, 33(8): 772-776.
11. Gerber JP, Marcus RL, Dibble LE, et al. Effects of early progressive eccentric exercise on muscle size and function after anterior cruciate ligament reconstruction: a 1-year follow-up study of a randomized clinical trial. Phys Ther, 2009, 89(1): 51-59.
12. 楊偉毅, 練文興, 曹學偉, 等. 肌力強化訓練對膝關節前交叉韌帶重建術后伴股四頭肌萎縮患者肌力恢復的療效. 實用醫學雜志, 2012, 28(13): 2221-2223.
13. Morrissey MC, Drechsler WI, Morrissey D, et al. Effects of distally fixated versus nondistally fixated leg extensor resistance training on knee pain in the early period after anterior cruciate ligament reconstruction. Phys Ther, 2002, 82(1): 35-43.
14. Perry MC, Morrissey MC, King JB, et al. Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2005, 13(5): 357-369.
15. Chao WC, Shih JC, Chen KC, et al. The effect of functional movement training after anterior cruciate ligament reconstruction: a randomized controlled trial. J Sport Rehabil, 2018, 27(6): 541-545.
16. 單萍, 肖海濤. 本體感覺訓練在關節鏡下前交叉韌帶重建術后患者中的應用研究. 臨床與病理雜志, 2016, 36(1): 1-6.
17. MehMet U, Koca I, Eroglu M, et al. Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction. J Phys Ther Sci, 2014, 26(12): 1875-1878.
18. 熊道海, 李玥瑩, 張云. 前交叉韌帶重建術后康復治療中開鏈與閉鏈運動的效果觀察. 南京醫科大學學報(自然科學版), 2013, 33(7): 994-998.
19. Baumgart C, Schubert M, Hoppe MW, et al. Do ground reaction forces during unilateral and bilateral movements exhibit compensation strategies following ACL reconstruction? Knee Surg Sports Traumatol Arthrosc, 2017, 25(5): 1385-1394.
20. Akbari A, Ghiasi F, Mir M, et al. The effects of balance training on static and dynamic postural stability indices after acute ACL reconstruction. Glob J Health Sci, 2015, 8(4): 68-81.
21. 楊靜宜. 對運動療法分類和專用術語的意見和建議. 中國康復醫學雜志, 2005, 20(5): 371-373.
22. 張國寧, 王友. 膝關節評分標準的評估. 中華外科雜志, 2006, 44(16): 1141-1143.
23. 鮑瑞林. 膝關節交叉韌帶重建手術前后lysholm膝關節活動評分比較. 寧夏醫科大學學報, 2013, 35(12): 1410-1413.
24. Jewiss D, Ostman C, Smart N. Open versus closed kinetic chain exercises following an anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Sports Med, 2017, 2: 1-10.
25. Daniel J, Cecilia O, Neil S. Open versus closed kinetic chain exercises following an anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Sports Med (Hindawi Publ Corp), 2017, 2017: 4721548.
26. Perriman A, Leahy E, Semciw AI. The effect of open vs closed kinetic chain exercises on anterior tibial laxity, strength, and function following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Orthop Sport Phys, 2018, 48(7): 1-52.

Chinese Journal of Evidence-Based Medicine

Efficacy of exercise therapy on recovery of moto function after anterior cruciate ligament reconstruction: a meta-analysis

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