Updating Recommendations for Rehabilitation after ACL Reconstruction
Notice bibliographique
Résumé
OBJECTIVE: To review recent evidence in order to update previous systematic reviews on methods of rehabilitation after anterior cruciate ligament (ACL) reconstruction. DATA SOURCES: PubMed, Embase, and the Cochrane Controlled Trials Register were searched for the period January 2006 to December 2010, using terms related to ACL, rehabilitation, and randomized controlled trial (RCT). The search was done in triplicate, and the results reconciled (85 studies identified). STUDY SELECTION: Relevant studies in English that were peer-reviewed RCTs or prospective comparative studies evaluating methods of ACL rehabilitation were included (n = 29). Evidence was evaluated by all 3 authors using the CONSORT criteria. DATA EXTRACTION: The data extracted included number of patients, ACL reconstruction method, randomization method, intervention, length of, and loss to, follow-up, outcomes assessed, bias, and findings. The review included evidence on postoperative bracing, accelerated rehabilitation, home-based rehabilitation, proprioceptive and neuromuscular training, and miscellaneous topics that were investigated by single trials. MAIN RESULTS: In 6 studies of postoperative bracing, no study found a clinically significant benefit of bracing or of restricted range of knee motion for pain control, knee laxity, or rehabilitation. Postoperative treatment without the use of a brace was not associated with less favorable outcomes. In 5 studies of accelerated strengthening, beginning eccentric quadriceps strengthening and isokinetic hamstring strengthening 2 weeks after ACL surgery improved or accelerated strength gains. Immediately postoperative weight-bearing, range of knee motion from 0° to 90° of flexion, and strengthening with closed-chain exercises were probably all safe. Home-based rehabilitation was evaluated in 2 studies. One study demonstrated that this intervention was at least as successful as a standard accelerated program over the long term. The other study included very low compliance expectations and other methodologic problems that precluded a useful assessment of benefit. Nine trials of neuromuscular strengthening (including perturbation, vibration, and/or balance training by various means) compared with strength, traditional rehabilitation, or placebo found some small short-term benefits to proprioceptive training and no harm from any of the treatments. Vibration training in addition to other strengthening may lead to faster proprioceptive recovery but the benefits to overall functional outcome are less clear. A study of vitamin C and E supplementation found a correlation between higher presurgery vitamin C levels and greater strength at 3 months, but this strength increase was not related to postsurgical vitamin C supplementation. Hyaluronic acid injection at 8 weeks improved ambulation and peak torque more than other doses or placebo, but poor outcomes in the control group raise questions about the quality of the standard rehabilitation program. Running interval training and continuous active motion had unclear effects. Using the uninjured leg for single-leg cycling prevented the usual loss of aerobic fitness in the postoperative period. Preoperative and postoperative video instruction decreased expectations of pain and increased self-efficacy although it made no difference to performance. CONCLUSIONS: The review of rehabilitation interventions after ACL reconstruction suggests that both accelerated and home-based rehabilitation, neuromuscular training programs, hyaluronic acid injection, and single (uninjured) leg cycling may be beneficial. Preoperative and postoperative informational videos may be valuable for psychological well-being. Insufficient evidence was found to recommend bracing.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,120 | 0,359 |
| Méta-épidémiologie (sens strict) | 0,004 | 0,003 |
| Méta-épidémiologie (sens large) | 0,010 | 0,010 |
| Bibliométrie | 0,021 | 0,012 |
| Études des sciences et des technologies | 0,002 | 0,004 |
| Communication savante | 0,011 | 0,020 |
| Science ouverte | 0,012 | 0,009 |
| Intégrité de la recherche | 0,014 | 0,012 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,010 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».