PDF(Pubmed)
Abstract：
The increased prevalence of postoperative arthrofibrosis after multi-ligament knee injuries (MLKI) compared to isolated anterior cruciate ligament (ACL) injuries has been proposed to be due, in part, to patient factors limiting physical therapy utilization. The purpose of this study was to compare demographic factors, pre- and postoperative physical therapy utilization, and the need for motion-restoring surgery between MLKI and ACL-injured patients. Using the PearlDiver Mariner 151 database, two cohorts matched by age and sex were identified using current procedural terminology (CPT) codes and included those age 16 or greater that underwent isolated ACL (n=3801) vs. MLKI reconstruction (n=3801). The number of pre- and postoperative physical therapy visits was recorded, as was the need for motion-restoring surgery (arthroscopic lysis of adhesions or manipulation under anesthesia). Demographic factors, physical therapy utilization, and the prevalence of motion-restoring surgery were compared between the MLKI and ACL groups using t-tests or chi-square tests, as appropriate. A significantly greater proportion of those with MLKI underwent subsequent motion-restoring surgery (MLKI=412/3081 (13.4%) vs. ACL=84/3081 (2.7%), p<0.001; odds ratio = 5.5 (95% CI: 4.3, 7.0), p<0.0001). Following surgery, less than half of those with MLKI that underwent subsequent motion-restoring surgery attended physical therapy, which was significantly lower than those who did not require motion-restoring surgery (p<0.0001). The prevalence of motion-restoring surgery was significantly greater after MLKI when compared to an isolated ACL injury. While the etiology of arthrofibrosis after MLKI is likely complex, the current results suggest that demographic factors and physical therapy utilization are not solely responsible for the increased risk of arthrofibrosis after MLKI.
摘要：
与孤立的前交叉韧带（ACL）损伤相比，多韧带膝关节损伤（MLKI）术后关节纤维化的患病率增加，在某种程度上,限制物理治疗利用的患者因素。这项研究的目的是比较人口统计学因素，术前和术后物理治疗的利用，以及MLKI和ACL损伤患者之间需要恢复运动的手术。使用PearlDiver水手151数据库,使用当前程序术语（CPT）代码确定了两个按年龄和性别匹配的队列，其中包括16岁或以上接受孤立ACL（n=3801）与MLKI重建(n=3801)。记录物理治疗前后的就诊次数,以及需要恢复运动的手术(关节镜下粘连松解术或麻醉下操作)。人口因素,物理治疗的利用，使用t检验或卡方检验比较MLKI和ACL组之间的运动恢复手术的患病率，视情况而定。接受MLKI的患者中，有更多的比例接受了随后的运动恢复手术（MLKI=412/3081（13.4％）与ACL=84/3081（2.7%），p<0.001；比值比=5.5（95%CI：4.3，7.0），p<0.0001)。手术后,只有不到一半的MLKI患者接受了随后的运动恢复手术，接受了物理治疗，显着低于不需要运动恢复手术的患者（p<0.0001）。与孤立的ACL损伤相比，MLKI后恢复运动手术的患病率明显更高。虽然MLKI后关节纤维化的病因可能很复杂，目前的研究结果表明,人口统计学因素和物理疗法的使用并不是MLKI术后关节纤维化风险增加的唯一原因.
