切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 718 -724. doi: 10.3877/cma.j.issn.1674-134X.2021.06.011

所属专题: 指南共识

综述

前交叉韧带损伤处理相关国际指南解读及其临床应用
周天平1, 徐一宏1, 徐卫东1,()   
  1. 1. 200433 上海,海军军医大学附属长海医院关节骨病外科
  • 收稿日期:2021-07-09 出版日期:2021-12-01
  • 通信作者: 徐卫东

Interpretation and clinical application of international guidelines on management of anterior cruciate ligament injuries

Tianping Zhou1, Yihong Xu1, Weidong Xu1,()   

  1. 1. Department of Orthopedics, Changhai Hospital, The Navy Medical University, Shanghai 200433, China
  • Received:2021-07-09 Published:2021-12-01
  • Corresponding author: Weidong Xu
引用本文:

周天平, 徐一宏, 徐卫东. 前交叉韧带损伤处理相关国际指南解读及其临床应用[J]. 中华关节外科杂志(电子版), 2021, 15(06): 718-724.

Tianping Zhou, Yihong Xu, Weidong Xu. Interpretation and clinical application of international guidelines on management of anterior cruciate ligament injuries[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 718-724.

前交叉韧带损伤是一种常见的膝关节运动损伤。前交叉韧带损伤后的病人往往需要及时、有效的医学干预。但是目前临床医生在前交叉韧带损伤诊断、手术指征选择、手术方式、移植物类型、术后康复方案以及重返运动评估方面仍然存在较大困惑与争议。因此近年来国际权威研究机构和组织纷纷发布了基于当前研究水平的前交叉韧带损伤的处理指南或共识。这些指南之间既有继承又有发展,甚至有冲突之处。本研究通过对这些指南的系统解读与分析总结,归纳出目前临床上主要研究问题的最佳处理建议,为临床医生提供借鉴。

Anterior cruciate ligament (ACL) injury has always been the most common sport injury of the knee. It is necessary to provide timely and effective medical treatment to patients suffering anterior cruciate ligament injury. However, clinicians have confusion in diagnosis of anterior cruciate ligament injury, surgical indications, surgical methods, graft types, rehabilitation program as well as return-to-sport tests. Thus s series of ACL treatment guidelines and consensuses have been published by some international research organizations based on the available knowledge. Besides, there are inheritance, development and even controversies among these guidelines. In this article, treatment suggestions to controversial clinical issues were summarized after thoroughly interpretation and analysis of these guidelines. It is hoped to provide reference for clinicians.

表1 ACL损伤相关指南及其主要内容
时间 机构/组织 题目 主要内容
2020 美洲豹研讨会ACL共识小组(The Panther Symposium ACL Treatment Consensus Group) Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group 前交叉韧带重建手术指征相关问题
2020 美洲豹研讨会ACL共识小组 Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group 前交叉韧带损伤的临床结局评估相关问题
2020 美洲豹研讨会ACL共识小组 Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group 前交叉韧带损伤后重返运动相关问题
2019 日本骨科协会(Japanese Orthopaedic Association,JOA) Japanese Orthopaedic Association 2019 guidelines for anterior cruciate ligament injuries (3rd edition) ACL损伤的危险因素、诊断、评估、治疗及康复相关问题
2018 意大利关节镜,膝关节,上肢,运动,软骨和骨科学会(Italian Society of Arthroscopy, Knee, Upper Limb, Sports, Cartilage and Orthopaedic Technologies, SIGASCOT) Italian consensus statement for the use of allografts in ACL reconstructive surgery ACL重建中异体肌腱移植物的应用问题
2016 荷兰皇家理疗学会(The Royal Dutch Society for Physical Therapy,KNGF) Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus ACL损伤及重建后康复相关问题
2015 美国骨科学会(The American Academy Of Orthopaedic Surgery, AAOS) The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Anterior Cruciate Ligament Injuries ACL损伤处理的基本原则问题
2014 骨科多中心协作网(Multicenter Orthopaedic Outcomes Network, MOON) Anterior Cruciate Ligament Reconstruction Rehabilitation: MOON Guidelines ACL重建术后康复问题
2012 荷兰骨科协会(Dutch Orthopaedic Association,NOV) Guideline on anterior cruciate ligament injury A multidisciplinary review by the Dutch Orthopaedic Association ACL损伤的诊断及治疗问题
[1]
Granan LP, Bahr R, Steindal K, et al. Development of a National cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry[J]. Am J Sports Med, 2008, 36(2): 308-315.
[2]
Brambilla L, Pulici L, Carimati G, et al. Prevalence of associated lesions in anterior cruciate ligament reconstruction: correlation with surgical timing and with patient age, sex, and body mass index[J]. Am J Sports Med, 2015, 43(12): 2966-2973.
[3]
Diermeier T, Rothrauff BB, Engebretsen L, et al. Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(8): 2390-2402.
[4]
Svantesson E, Hamrin Senorski E, Webster KE, et al. Clinical outcomes after anterior cruciate ligament injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(8): 2415-2434.
[5]
Meredith SJ, Rauer T, Chmielewski TL, et al. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group[J]. J ISAKOS, 2021, 6(3): 138-146.
[6]
Ishibashi Y, Adachi N, Koga H, et al. Japanese orthopaedic association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury-secondary publication[J]. J Orthop Sci, 2020, 25(1): 6-45.
[7]
Bait C, Randelli P, Compagnoni R, et al. Italian consensus statement for the use of allografts in ACL reconstructive surgery[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(6): 1873-1881.
[8]
Van MN, Van CR, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus[J]. Br J Sports Med, 2016, 50(24): 1506-1515.
[9]
Shea KG, Carey JL, Richmond J, et al. The American academy of orthopaedic surgeons evidence-based guideline on management of anterior cruciate ligament injuries[J]. J Bone Joint Surg Am, 2015, 97(8): 672-674.
[10]
Wright RW, Haas AK, Anderson J, et al. Anterior cruciate ligament reconstruction rehabilitation: MOON guidelines[J]. Sports Health, 2015, 7(3): 239-243.
[11]
Meuffels DE, Poldervaart MT, Diercks RL, et al. Guideline on anterior cruciate ligament injury[J]. Acta Orthop, 2012, 83(4): 379-386.
[12]
Stanley LE, Kerr ZY, Dompier TP, et al. Sex differences in the incidence of anterior cruciate ligament, medial collateral ligament, and meniscal injuries in collegiate and high school sports: 2009-2010 through 2013-2014[J]. Am J Sports Med, 2016, 44(6): 1565-1572.
[13]
Lansdown D, Ma CB. The influence of tibial and femoral bone morphology on knee kinematics in the anterior cruciate ligament injured knee[J]. Clin Sports Med, 2018, 37(1): 127-136.
[14]
Dare DM, Fabricant PD, Mccarthy MM, et al. Increased lateral tibial slope is a risk factor for pediatric anterior cruciate ligament injury: an MRI-based case-control study of 152 patients[J]. Am J Sports Med, 2015, 43(7): 1632-1639.
[15]
Fahim SM, Dhawan T, Jagadeesh N, et al. The relationship of anterior cruciate ligament injuries with MRI based calculation of femoral notch width, notch width index, notch shape - a randomized control study[J/OL]. J Clin Orthop Trauma, 2021, 17: 5-10. DOI: 10.1016/j.jcot.2021.01.006.
[16]
Al-Saeed O, Brown M, Athyal R, et al. Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(3): 678-682.
[17]
Zebis MK, Andersen LL, Brandt M, et al. Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial[J]. Br J Sports Med, 2016, 50(9): 552-557.
[18]
Westin M, Reeds-Lundqvist S, Werner S. The correlation between anterior cruciate ligament injury in elite alpine skiers and their parents[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(3): 697-701.
[19]
Dischiavi SL, Wright AA, Heller RA, et al. Do ACL injury risk reduction exercises reflect common injury mechanisms? A scoping review of injury prevention programs[J/OL]. Sports Health, 2021: 19417381211037966. DOI: 10.1177/19417381211037966.
[20]
Song GY, Ni QK, Zheng T, et al. Slope-reducing tibial osteotomy combined with primary anterior cruciate ligament reconstruction produces improved knee stability in patients with steep posterior tibial slope, excessive anterior tibial subluxation in extension, and chronic meniscal posterior horn tears[J]. Am J Sports Med, 2020, 48(14): 3486-3494.
[21]
Leblanc MC, Kowalczuk M, Andruszkiewicz N, et al. Diagnostic accuracy of physical examination for anterior knee instability: a systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2805-2813.
[22]
Zhao M, Zhou Y, Chang J, et al. The accuracy of MRI in the diagnosis of anterior cruciate ligament injury[J/OL]. Ann Transl Med, 2020, 8(24): 1657. DOI: 10.21037/atm-20-7391.
[23]
Grevnerts HT, Sonesson S, Gauffin H, et al. Decision making for treatment after ACL injury from an orthopaedic surgeon and patient perspective: results from the NACOX study[J/OL]. Orthop J Sports Med, 2021, 9(4): 23259671211005090. DOI: 10.1177/23259671211005090.
[24]
Hoogeslag R, Buitenhuis MB, Brouwer RW, et al. Standard MRI May not predict specific acute anterior cruciate ligament rupture characteristics[J/OL]. Orthop J Sports Med, 2021, 9(3): 2325967121992472. DOI: 10.1177/2325967121992472.
[25]
曾小龙,钟国庆,黄文汉,等.基于运动捕捉膝关节运动分析及临床常规评估进展[J/CD].中华关节外科杂志(电子版)202115(3):334-338.
[26]
Konrads C, Döbele S, Ateschrang A, et al. Outcome of anterior cruciate ligament reconstruction in children and adolescents: a retrospective study[J/OL]. J Clin Orthop Trauma, 2021, 13:46-49. DOI: 10.1016/j.jcot.2020.08.022.
[27]
Pennock A, Murphy MM, Wu M. Anterior cruciate ligament reconstruction in skeletally immature patients[J]. Curr Rev Musculoskelet Med, 2016, 9(4): 445-453.
[28]
Chalmers PN, Mall NA, Moric M, et al. Does ACL Reconstruction alter natural history? A systematic literature review of long-term outcomes[J]. J Bone Joint Surg Am, 2014, 96(4): 292-300.
[29]
Tan CW, Hsu WH, Yu P, et al. Anterior cruciate ligament reconstruction in patients older than 50 years: a systematic review and meta-analysis[J/OL]. Orthop J Sports Med, 2020, 8(4): 2325967120915698. DOI: 10.1177/2325967120915698.
[30]
Kim SH, Seo HJ, Seo DW, et al. Analysis of risk factors for ramp lesions associated with anterior cruciate ligament injury[J]. Am J Sports Med, 2020, 48(7): 1673-1681.
[31]
Tashiro Y, Okazaki K, Murakami K, et al. Anterolateral rotatory instability in vivo correlates tunnel position after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft[J]. World J Orthop, 2017, 8(12): 913-921.
[32]
Chen L, Wu Y, Lin G, et al. Graft bending angle affects allograft tendon maturity early after anterior cruciate ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10):3048-3054.
[33]
Arnold MP, Calcei JG, Vogel N, et al. ACL study group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(11): 3871-3876.
[34]
Horstmann H, Petri M, Tegtbur U, et al. Quadriceps and hamstring tendon autografts in ACL reconstruction yield comparably good results in a prospective, randomized controlled trial[J/OL]. Arch Orthop Trauma Surg, 2021. DOI: 10.1007/s00402-021-03862-8.
[35]
Widner M, Dunleavy M, Lynch S. Outcomes following ACL reconstruction based on graft type: are all grafts equivalent?[J]. Curr Rev Musculoskelet Med, 2019, 12(4): 460-465.
[36]
Kitaguchi T, Tanaka Y, Takeshita S, et al. Preoperative quadriceps strength as a predictor of return to sports after anterior cruciate ligament reconstruction in competitive athletes[J/OL]. Phys Ther Sport, 2020, 45: 7-13. DOI: 10.1016/j.ptsp.2020.06.001.
[37]
Carter HM, Littlewood C, Webster KE, et al. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review[J/OL]. BMC Musculoskelet Disord, 2020, 21(1): 647. DOI: 10.1186/s12891-020-03676-6.
[38]
Cristiani R, Mikkelsen C, Wange P, et al. Autograft type affects muscle strength and hop performance after ACL reconstruction. A randomised controlled trial comparing patellar tendon and hamstring tendon autografts with standard or accelerated rehabilitation[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(9): 3025-3036.
[39]
Wu J, Kator JL, Zarro M, et al. Rehabilitation principles to consider for anterior cruciate ligament repair[J/OL]. Sports Health, 2021: 19417381211032949. DOI: 10.1177/19417381211032949.
[40]
van groningen B, van Der Steen MC, Janssen DM, et al. Assessment of graft maturity after anterior cruciate ligament Reconstruction using autografts: a systematic review of biopsy and magnetic resonance imaging studies[J]. Arthrosc Sports Med Rehabil, 2020, 2(4): e377-e388.
[41]
MOON Group, Everhart JS, Jones MH, et al. The clinical radiographic incidence of posttraumatic osteoarthritis 10 years after anterior cruciate ligament reconstruction: data from the MOON nested cohort[J]. Am J Sports Med, 2021, 49(5): 1251-1261.
[42]
Baron JE, Duchman KR, Wolf BR, et al. PROMIS is a valid patient-reported outcome measure for patients undergoing ACL reconstruction with multi-ligament knee reconstruction and repair procedures[J]. Knee, 2021, 28: 294-299.
[43]
Tortoli E, Francini L, Giovannico G, et al. Translation, cross-cultural adaptation and validation of the Italian version of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale[J/OL]. Knee Surg Sports Traumatol Arthrosc, 2020. DOI: 10.1007/s00167-020-06169-0.
[1] 林文, 王雨萱, 许嘉悦, 王矜群, 王睿娜, 何董源, 樊沛. 人工关节置换登记系统的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 834-841.
[2] 黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[3] 杨国栋, 张辉, 郭珈, 曲迪, 张静, 戚超. 外侧半月板后角撕裂是否修复的术后疗效对比[J]. 中华关节外科杂志(电子版), 2023, 17(05): 619-624.
[4] 卫杨文祥, 黄浩然, 刘予豪, 陈镇秋, 王海彬, 周驰. 股骨头坏死细胞治疗的前景和挑战[J]. 中华关节外科杂志(电子版), 2023, 17(05): 694-700.
[5] 梁家敏, 黄子荣, 崔家鸣, 钟名金, 冯文哲, 陈康, 胡艳, 欧阳侃, 杨雷, 王大平, 王满宜, 朱伟民. 前交叉韧带保留残端重建促进膝关节功能的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 708-714.
[6] 邢阳, 何爱珊, 康焱, 杨子波, 孟繁钢, 邬培慧. 前交叉韧带单束联合前外侧结构重建的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 508-519.
[7] 郭春花, 徐晓燕, 何劼, 刘晓洁, 孟庆芳, 杨曦, 江珉, 刘铁成. 反重力跑台系统在前交叉韧带重建术后步行训练的应用[J]. 中华关节外科杂志(电子版), 2023, 17(04): 485-491.
[8] 王旭, 李彦林, 王国梁, 赵正吕, 贾笛, 宁梓文, 施政良, 何璐, 王坤. 关节镜下带线锚钉缝合修复前交叉韧带部分损伤的疗效分析[J]. 中华关节外科杂志(电子版), 2023, 17(03): 326-333.
[9] 周兰, 徐一宏, 徐卫东. 前交叉韧带重建术后重返运动的评估[J]. 中华关节外科杂志(电子版), 2023, 17(03): 409-414.
[10] 赵宇, 赵松, 赵金忠. 前交叉韧带损伤及重建后继发性膝骨关节炎的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(03): 415-423.
[11] 刘延子, 王维军, 韩向东, 田学东. 保留残余腱束与残端重建前交叉韧带后外侧束[J]. 中华关节外科杂志(电子版), 2023, 17(03): 439-442.
[12] 白雪, 李珺, 邢婵, 高济越, 赵海东. 中华医学会乳腺癌术后淋巴水肿临床实践指南解读[J]. 中华普外科手术学杂志(电子版), 2023, 17(03): 245-249.
[13] 邱红生, 林树体, 梁朝莹, 劳世高, 何荷. 模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 343-350.
[14] 陈静, 逯艳艳, 徐耀东, 马颖才. 联动成像技术在肠道病变中的研究进展[J]. 中华胃肠内镜电子杂志, 2023, 10(03): 195-199.
[15] 王擎, 王冠峰, 陈星. 胃食管阀瓣的Hill分级在胃食管反流病中的应用价值[J]. 中华胃肠内镜电子杂志, 2023, 10(02): 125-130.
阅读次数
全文


摘要