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. 前十字韧带断裂继发半月板损害的临床研究. 中华骨科杂志, 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, 王谦, 李箭. 系统康复训练对运动爱好者前交叉韧带重建术后运动功能恢复的临床疗效. 华西医学, 2018, 33(9): 1134-1137.
6.	黄超, 吴听, 赵克佳, 等. 系统化康复训练路径在前交叉韧带重建后膝关节本体感觉功能训练中的应用效果. 护理实践与研究, 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.	陈柯, 张杰敏, 张馨梅, 等. 阶段性系统康复锻炼在膝关节前交叉韧带损伤重建术后的应用效果. 西部医学, 2016, 28(4): 560-563.
9.	王海霞, 陈捷, 程小芸, 等. 康复训练在关节镜下前交叉韧带重建术患者功能恢复中的应用研究. 护理实践与研究, 2015, 12(12): 149-150.
10.	张晓辉, 廖八根, 陈速, 等. 神经肌肉训练对运动员前交叉韧带重建术后康复的影响. 中国运动医学杂志, 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.	杨伟毅, 练文兴, 曹学伟, 等. 肌力强化训练对膝关节前交叉韧带重建术后伴股四头肌萎缩患者肌力恢复的疗效. 实用医学杂志, 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.	单萍, 肖海涛. 本体感觉训练在关节镜下前交叉韧带重建术后患者中的应用研究. 临床与病理杂志, 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, 李玥莹, 张云. 前交叉韧带重建术后康复治疗中开链与闭链运动的效果观察. 南京医科大学学报(自然科学版), 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.	杨静宜. 对运动疗法分类和专用术语的意见和建议. 中国康复医学杂志, 2005, 20(5): 371-373.
22.	张国宁, 王友. 膝关节评分标准的评估. 中华外科杂志, 2006, 44(16): 1141-1143.
23.	鲍瑞林. 膝关节交叉韧带重建手术前后lysholm膝关节活动评分比较. 宁夏医科大学学报, 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. 前十字韧带断裂继发半月板损害的临床研究. 中华骨科杂志, 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, 王谦, 李箭. 系统康复训练对运动爱好者前交叉韧带重建术后运动功能恢复的临床疗效. 华西医学, 2018, 33(9): 1134-1137.
6. 黄超, 吴听, 赵克佳, 等. 系统化康复训练路径在前交叉韧带重建后膝关节本体感觉功能训练中的应用效果. 护理实践与研究, 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. 陈柯, 张杰敏, 张馨梅, 等. 阶段性系统康复锻炼在膝关节前交叉韧带损伤重建术后的应用效果. 西部医学, 2016, 28(4): 560-563.
9. 王海霞, 陈捷, 程小芸, 等. 康复训练在关节镜下前交叉韧带重建术患者功能恢复中的应用研究. 护理实践与研究, 2015, 12(12): 149-150.
10. 张晓辉, 廖八根, 陈速, 等. 神经肌肉训练对运动员前交叉韧带重建术后康复的影响. 中国运动医学杂志, 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. 杨伟毅, 练文兴, 曹学伟, 等. 肌力强化训练对膝关节前交叉韧带重建术后伴股四头肌萎缩患者肌力恢复的疗效. 实用医学杂志, 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. 单萍, 肖海涛. 本体感觉训练在关节镜下前交叉韧带重建术后患者中的应用研究. 临床与病理杂志, 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, 李玥莹, 张云. 前交叉韧带重建术后康复治疗中开链与闭链运动的效果观察. 南京医科大学学报(自然科学版), 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. 杨静宜. 对运动疗法分类和专用术语的意见和建议. 中国康复医学杂志, 2005, 20(5): 371-373.
22. 张国宁, 王友. 膝关节评分标准的评估. 中华外科杂志, 2006, 44(16): 1141-1143.
23. 鲍瑞林. 膝关节交叉韧带重建手术前后lysholm膝关节活动评分比较. 宁夏医科大学学报, 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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