Abstract：
OBJECTIVE: To summarize the effectiveness of management strategies and rehabilitation approaches for knee joint structural and molecular biomarker outcomes following anterior cruciate ligament (ACL) and/or meniscal tear. DESIGN: Intervention systematic review. LITERATURE SEARCH: We searched the MEDLINE, Embase, CINAHL, CENTRAL, and SPORTDiscus databases from their inception up to November 3, 2021. STUDY SELECTION CRITERIA: We included randomized controlled trials (RCTs) investigating the effectiveness of management strategies or rehabilitation approaches for structural/molecular biomarkers of knee joint health following ACL and/or meniscal tear. DATA SYNTHESIS: We included 5 RCTs (9 papers) with primary ACL tear (n = 365). Two RCTs compared initial management strategies (rehabilitation plus early vs optional delayed ACL surgery), reporting on structural biomarkers (radiographic osteoarthritis, cartilage thickness, meniscal damage) in 5 papers and molecular biomarkers (inflammation, cartilage turnover) in 1 paper. Three RCTs compared different post-ACL reconstruction (ACLR) rehabilitation approaches (high vs low intensity plyometric exercises, accelerated vs nonaccelerated rehabilitation, continuous passive vs active motion), reporting on structural biomarkers (joint space narrowing) in 1 paper and molecular biomarkers (inflammation, cartilage turnover) in 2 papers. RESULTS: There were no differences in structural or molecular biomarkers between post-ACLR rehabilitation approaches. One RCT comparing initial management strategies demonstrated that rehabilitation plus early ACLR was associated with greater patellofemoral cartilage thinning, elevated inflammatory cytokine response, and reduced incidence of medial meniscal damage over 5 years compared to rehabilitation with no/delayed ACLR. CONCLUSION: Very low-certainty evidence suggests that different initial management strategies (rehabilitation plus early vs optional delayed ACL surgery) but not postoperative rehabilitation approaches may influence the incidence of meniscal damage, patellofemoral cartilage loss and cytokine concentrations over 5 years post-ACL tear. J Orthop Sports Phys Ther 2023;53(4):1-22. Epub: 20 February 2023. doi:10.2519/jospt.2023.11576.
摘要：
目的：总结前交叉韧带（ACL）和/或半月板撕裂后膝关节结构和分子生物标志物结果的管理策略和康复方法的有效性。设计：干预性系统评价文献搜索：MEDLINE，EMBASE,CINAHL,中部,和SportDiscus至2021年11月3日。研究选择标准：研究ACL和/或半月板撕裂后膝关节健康的结构/分子生物标志物的管理策略或康复方法的有效性的随机对照试验（RCT）。数据综合：我们纳入了5篇RCT（9篇论文）与原发性ACL撕裂（n=365）。两个RCT比较了初始管理策略（康复+早期与可选的延迟ACL手术），关于结构生物标志物的报告(放射学骨关节炎，软骨厚度,半月板损伤)在五篇论文和分子生物标志物(炎症，软骨周转）在一篇论文中。三个随机对照试验比较了不同的ACL后重建（ACLR）康复方法（高强度和低强度的屈光度锻炼，加速与非加速康复，连续被动与主动运动)，在一篇论文中报告结构生物标志物(关节空间变窄)和分子生物标志物(炎症，软骨周转）在两篇论文中。结果：ACLR后康复方法在结构或分子生物标志物方面没有差异。一项比较初始管理策略的RCT表明，康复+早期ACLR与更大的髌股软骨变薄相关，炎症细胞因子反应升高，与无/延迟ACLR的康复相比，五年内内侧半月板损伤的发生率降低。结论：非常低的确定性证据表明，不同的初始管理策略（康复+早期与可选的延迟ACL手术），但术后康复方法可能不会影响半月板损伤的发生率，ACL撕裂后5年髌股软骨损失和细胞因子浓度。
