一般認為前十字韌帶損傷是必須手術重建的; 但若患者不是運動員, 或許仍然有保守治療的空間, 前提是必須接受完整的復建與運動訓練, 輔以活動調整, 應該可以獲得持續的功能恢復 (see below)
picture from: http://bme.biomed.dal.ca/pgratzer/ACL-tear-01f.jpg
-----------------------------------------------------------------------------------------------------------------------------------
15-Year Follow-up of Neuromuscular Function in Patients With Unilateral Nonreconstructed Anterior Cruciate Ligament Injury Initially Treated With Rehabilitation and Activity Modification: A Longitudinal Prospective Study
ACSM 2007 Aug http://ajs.sagepub.com/cgi/content/abstract/0363546507305018v2?papetoc
Abstract
Background: It has been suggested that neuromuscular function is of importance in the overall outcome after anterior cruciate ligament (ACL) injury.
Hypothesis: Good neuromuscular function can be achieved and maintained over time in subjects with ACL injury treated with rehabilitation and activity modification but without reconstructive surgery.
Study Design: Case series; Level of evidence, 4.
Methods: One hundred consecutive patients (42 women and 58 men) with acute ACL injury at a nonprofessional, recreational or competitive activity level were assessed 1, 3, and 15 years after injury. Their mean age at inclusion was 26 years (range, 1543 years). All patients initially underwent rehabilitation and were advised to modify their activity level, especially by avoiding contact sports. Patients with recurrent giving-way episodes or secondary meniscal injuries that required fixation were subsequently excluded and underwent reconstruction of the ACL. Sixty-seven patients (71% of those available for follow-up) with unilateral nonreconstructed injury remained at the 15-year follow-up. Fifty-six of these 67 patients were examined with the single-legged hop test for distance and knee muscle strength. The limb symmetry index (LSI), calculated by dividing the result for the injured leg by that of the uninjured leg and multiplying by 100, was used for comparisons over time (paired t test).
Results: The LSI for the single-legged hop test was higher at the 3-year follow-up (mean, 98.5%; standard deviation [SD], 7.6%) than at the 15-year follow-up (mean, 94.8%; SD, 10.5%) (mean difference, –3.7%; 95% confidence interval [CI], –6.1% to –1.2%; P = .004). The LSI for isometric extension was higher at the 15-year follow-up (mean, 97.2%; SD, 13.7%) than at the 1-year follow-up (mean, 88.2%; SD, 15.4%) (mean difference, 9.0%; 95% CI, 3.7% to 14.4%; P = .001). At the 15-year follow-up, between 69% and 85% of the patients had an LSI
90%.
Conclusions: Good functional performance and knee muscle strength can be achieved and maintained over time in the majority of patients with ACL injury treated with rehabilitation and early activity modification but without reconstructive surgery.
非運動員之前十字韌帶損傷, 經非手術之復健治療15年後功能仍佳 - 疼痛書房 Pain Studio - Yahoo!奇摩部落格
