臨床整形外科57巻7号

2022年07月発行

臨床経験

前十字靱帯再建術患者の術前待機期間が膝関節の関節内軟部組織損傷や身体機能に及ぼす影響—術前リハビリテーション非実施症例の特徴

著者： 藤田慎矢¹ 田中創¹ 碇博哉² 松田秀策² 徳永真巳² 吉本隆昌²

所属機関： ¹福岡整形外科病院 リハビリテーション科 ²福岡整形外科病院 整形外科

ページ範囲：P.897 - P.902

背景：前十字靱帯再建術(ACLR)症例の術前待機期間が膝関節内軟部組織損傷や身体機能に及ぼす影響について調査した．対象と方法：術前リハビリテーション(以下，術前リハ)を実施していないACLR患者95例を対象とした．受傷から手術までの待機期間が6カ月未満の早期群と6カ月以上の遅延群に分類し，両群間の半月板・軟骨損傷の有無，各種身体機能を評価した．結果：遅延群で軟骨損傷の発生率が高く，身体機能に改善を認めた．まとめ：術前待機期間が6カ月以上になると，術前リハを実施しなくても身体機能が改善したが，軟骨損傷の発生率は増加した．

参考文献

1) Salem H S, Shi W J, Tucker B S, et al. Contact versus noncontact anterior cruciate ligament injuries:is mechanism of injury predictive of concomitant knee pathology? Arthroscopy 2018;34(1):200-4.

2) Mehl J, Otto A, Baldino J B, et al. The ACL-deficient knee and the prevalence of meniscus and cartilage lesions:a systematic review and meta-analysis. Arch Orthop Trauma Surg 2019;139(6):819-41.

3) Louboutin H, Debarge R, Richou J, et al. Osteoarthritis in patients with anterior cruciate ligament rupture:a review of risk factors. Knee 2009;16(4):239-44.

4) Brambilla L, Pulici L, Carimati G, et al. Prevalence of associated lesions in anterior cruciate ligament reconstruction:correlation with surgical timing and with patient age, sex, and body mass index. Am J Sports Med 2015;43(12):2966-73.

5) 鈴木朱美，成田　淳，中島　拓・他．膝前十字靱帯再建術の手術待機期間による臨床成績の差異．日整外スポーツ医会誌2020；40(3)：395-97．

6) Eitzen I, Holm I, Risberg M. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med2009;43(5):371-6.

7) van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update:practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016;50(24):1506-15.

8) 宗田　大．前十字靱帯(ACL)損傷診療ガイドライン 2019(改訂)．整形外科2019；70(11)：1218-1218．

9) Shaarani SR, O'hare C, Quinn A, et al. Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction. Am J Sports Med 2013;41(9):2117-27.

10) Kilcoyne KG, Dickens JF, Haniuk E, et al. Epidemiology of meniscal injury associated with ACL tears in young athletes. Orthopedics 2012;35(3):208-12.

11) Prodromidis AD, Drosatou C, Mourikis A, et al. Relationship between timing of anterior cruciate ligament reconstruction and chondral injuries:a systematic review and meta-analysis. Am J Sports Med 2021;03635465211036141. doi:10.1177/03635465211036141.

12) Sajjadi MM, Okhovatpour MA, Ebrahimpour A, et al. Anterior cruciate ligament reconstruction surgery timing with respect to meniscal-chondral damage. Arch Trauma Res 2018;7(3):87-91.

13) Magnussen RA, Pedroza AD, Donaldson CT, et al. Time from ACL injury to reconstruction and the prevalence of additional intra-articular pathology:is patient age an important factor? Knee Surg Sports Traumato Arthrosc 2013;21(9):2029-34.

14) Li G, Moses JM, Papannagari R, et al. Anterior cruciate ligament deficiency alters the in vivo motion of the tibiofemoral cartilage contact points in both the anteroposterior and mediolateral directions. JBJS 2006;88(8):1826-34.

15) Van de Velde SK, Gill TJ, Li G. Evaluation of kinematics of anterior cruciate ligament-deficient knees with use of advanced imaging techniques, three-dimensional modeling techniques, and robotics. J Bone Joint Surg Am 2009;91(Suppl 1):108.

16) Cantin O, Lustig S, Rongieras F, et al. Outcome of cartilage at 12 years of follow-up after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2016;102(7):857-61.

17) Tiderius CJ, Olsson LE, Nyquist F, et al. Cartilage glycosaminoglycan loss in the acute phase after an anterior cruciate ligament injury:delayed gadolinium-enhanced magnetic resonance imaging of cartilage and synovial fluid analysis. Arthritis Rheum 2005;52(1):120-7.

18) Thomas AC, Palmieri-Smith RM. Knee frontal-plane biomechanics in adults with or without bone marrow edema-like lesions after anterior cruciate ligament injury. J Athl Train 2017;52(6):581-6.

19) Alshewaier S, Yeowell G, Fatoye F. The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury:a systematic review. Clin Rehabil 2017;31(1):34-44.