目的:对随机对照试验(RCT)进行系统评价和荟萃分析,评估前交叉韧带重建(ACLR)后血流限制(BFR)训练与非BFR康复方案的神经肌肉和临床结局。
方法:根据2020年系统评价和荟萃分析首选报告项目指南,通过查询PubMed,MEDLINE,Scopus,Cochrane系统评价数据库,和Cochrane中央对照试验注册数据库从开始到2023年12月,以确定评估ACLR与非BFR康复后BFR训练结果的I-II级RCT。使用具有标准化平均差异(SMD)的随机效应模型对疼痛进行荟萃分析,肌肉力量,和肌肉体积,同时计算患者报告结局指标的平均差(MD)。
结果:八个RCT,由245名患者组成,符合纳入标准,115例接受非BFR康复的患者与130例接受ACLR后BFR康复的患者。患者平均年龄为27.2±6.7岁,大多数患者是男性(63.3%,n=138/218)。BFR康复方案的长度最常见的是8-12周(范围,14天-16周)。大多数研究将BFR组的肢体/动脉闭塞压力设定为80%。与非BFR康复相比,BFR导致等速肌力的显着改善(SMD:0.77,p=0.02,I2:58%),IKDC评分(MD:10.97,p=<.00001,I2:77%),和疼痛(SMD:1.52,p=.04,I2:87%),但不是股四头肌体积(SMD:0.28,p=0.43,I2:76%)。
结论:ACLR后使用BFR可改善疼痛,IKDC评分和等速肌力,基于股四头肌力量的可变结果,与非BFR康复相比,体积和厚度。
OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating neuromuscular and clinical outcomes of blood flow restriction (BFR) training after anterior cruciate ligament reconstruction (
ACLR) compared to non-BFR rehabilitation protocols.
METHODS: A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines by querying PubMed, MEDLINE, Scopus, the Cochrane Database for Systematic Review, and the Cochrane Central Register for Controlled Trials databases from inception through December 2023 to identify Level I-II RCTs evaluating outcomes of BFR training after
ACLR compared to non-BFR rehabilitation. A meta-analysis was performed using random-effects models with standardized mean difference (SMD) for pain, muscle strength, and muscle volume, while mean difference (MD) was calculated for patient-reported outcome measures.
RESULTS: Eight RCTs, consisting of 245 patients, met inclusion criteria, with 115 patients undergoing non-BFR rehabilitation versus 130 patients undergoing BFR after
ACLR. Mean patient age was 27.2 ± 6.7 years, with the majority of patients being male (63.3%, n=138/218). The length of the BFR rehabilitation protocol was most commonly between 8-12 weeks (range, 14 days - 16 weeks). The majority of studies set the limb/arterial occlusion pressure in the BFR group at 80%. When compared to non-BFR rehabilitation, BFR resulted in significant improvement in isokinetic muscle strength (SMD: 0.77, p=0.02, I2: 58%), IKDC score (MD: 10.97, p=<.00001, I2: 77%), and pain (SMD: 1.52, p=.04, I2: 87%), but not quadriceps muscle volume (SMD: 0.28, p=0.43, I2: 76%).
CONCLUSIONS: The use of BFR following
ACLR led to improvements in pain, IKDC score and isokinetic muscle strength, with variable outcomes based on quadriceps strength, volume and thickness when compared to non-BFR rehabilitation.