运动丧失（LOM）仍然是前交叉韧带（ACL）重建后的常见并发症，并且可能对手术后的患者预后有害。LOM是多因素的，但是这个复杂问题的非手术和手术解决方案是可用的。缺乏评估ACL重建后LOM患者手术治疗后临床结果的质量数据。
ACL重建后接受手术粘连松解术和在麻醉下进行LOM操作的患者将表现出功能下降，结果得分较低，与没有LOM的匹配控件相比，释放播放时间有所延迟。
队列研究；证据水平，3.
从2013年至2017年收集了1572例ACL重建患者的数据库，以确定总共58例患者（LOM组[n=29]与对照组[n=29]）。对需要再次进行LOM手术的患者与ACL重建后匹配的对照组进行分组比较，以了解手术时机的差异。自我报告的国际膝关节残疾委员会成绩，释放时的目标功能，和主观膝关节功能在2年与单一评估数字评估。对于所有统计分析，I型错误的风险设置为α=.05。
ACL重建后在麻醉下接受粘连松解术和LOM操作的患者在2年时与匹配的对照组相比，膝关节功能的单一评估数字评估没有差异（85.8±14.9vs88.0±10.8，P=.606）。所有患者均符合释放标准。只有国际膝关节残疾委员会评分(P=.046)和单腿跳床测试(P=.050)达到统计学上的显著差异,对照组得分较高。对照组和手术组之间的释放时间（P=.034）或参与水平（P=.180）没有差异。2年时的主观功能评分在组间没有显着差异。对照组在索引ACL重建期间的止血带时间较短（P=.034）。
这项研究的结果表明，在ACL重建后接受LOM手术治疗的患者可以在相似的时间释放，但与匹配的对照组相比，单腿跳跃对称性和自我报告功能相对不足。较长的手术时间可能会增加ACL重建后LOM的风险。
NCT03704376（ClinicalTrials.gov标识符）。
Loss of motion (LOM) remains a common complication after anterior cruciate ligament (ACL) reconstruction and can be detrimental to patient outcomes after surgery. LOM is multifactorial, but nonsurgical and surgical solutions to this complex problem are available. A paucity of quality data exists evaluating clinical outcomes after the surgical treatment of patients with LOM after ACL reconstruction.
Patients undergoing surgical lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction will exhibit decreased function, lower outcome scores, and delayed time of release to play when compared with matched controls without LOM.
Cohort study; Level of evidence, 3.
A database of 1572 patients undergoing ACL reconstruction was sampled from 2013 to 2017 to identify a total of 58 patients (LOM group [n = 29] vs matched control group [n = 29]). Group comparisons were examined for patients requiring a second surgical procedure for LOM versus matched controls after ACL reconstruction for differences in surgical timing, self-reported International Knee Disability Committee scores, objective function at release to play, and subjective knee function at 2 years with the Single Assessment Numeric Evaluation. The risk of a type I error was set at α = .05 for all statistical analyses.
Patients who underwent lysis of adhesions and manipulation under anesthesia for LOM after ACL reconstruction exhibited no differences in Single Assessment Numeric Evaluation knee function at 2 years when compared with matched controls (85.8 ± 14.9 vs 88.0 ± 10.8, P = .606). All patients met release-to-play criteria. Only International Knee Disability Committee scores (P = .046) and single-legged hop testing (P = .050) reached statistically significant differences, with higher scores in the control group. There was no difference in the time to release to play (P = .034) or level of participation (P = .180) between the control and surgical groups. Subjective function scores at 2 years were not significantly different between groups. Tourniquet time during the index ACL reconstruction was shorter in the control group (P = .034).
The findings of this study suggest that patients who undergo surgical treatment for LOM after ACL reconstruction can release to play at similar times but display relative deficits in single-legged-hop symmetry and lower self-reported function when compared with matched controls. Longer surgical times may increase the risk for LOM after ACL reconstruction.
NCT03704376 (ClinicalTrials.gov identifier).
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