Objective: To investigate the effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament (ACL) reconstruction, and summarize the relevant rules to guide the clinic.
Methods: Between August 2016 and December 2016, forty patients underwent arthroscopic ACL reconstruction using hamstring tendon were randomly divided into isokinetic group and control group ( n=20). The two groups of patients underwent staged rehabilitation treatment. The isokinetic group replaced the traditional intervention with the corresponding isokinetic strength training from 3 to 6 months after operation, and the traditional rehabilitation intervention was used in the control group. Finally, 12 cases of isokinetic group and 12 cases of control group with complete follow-up were enrolled in study. There was no significant difference in gender, age, body mass index, side of injury, the interval between injury and operation, and preoperative International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The peak torque (PT) of knee extension and flexion and hamstring quadriceps ratio (H/Q) were measured at 3 months, 6 months, 12 months, and the second-look arthroscopy. The MRI examination was performed at the same time to evaluate graft remodeling. The shape, tension, and degree of vascularization of grafts were observed under arthroscopy. The grafts were harvested and observed by HE staining.
Results: The invertal between ACL reconstruction and the second-look arthroscopy was (23.57±3.23) months in isokinetic group and (23.22±3.56) months in control group, showing no significant difference between the two groups ( P>0.05). At the second-look arthroscopy, the IKDC score was 90.45±4.73 in isokinetic group and 89.32±4.54 in control group, showing significant differences when compared with preoperative scores in the two groups ( P<0.05). But there was no significant difference between the two groups ( t=0.868， P=0.404). At 3 months after operation, there was no significant difference in the PT of knee extension and flexion between the two groups ( P>0.05). At 6 months, 12 months, and the second-look arthroscopy, the PT of knee extension and flexion in isokinetic group were higher than those in control group ( P<0.05). The H/Q at 6 months and 12 months were higher in isokinetic group than in control group, and the differences were significant ( P<0.05). There was no significant difference in MRI score between the two groups at 3 months, 6 months, and the second-look arthroscopy ( P>0.05). The MRI score at 12 months was significantly higher in isokinetic group than in control group ( P<0.05). At the second-look arthroscopy, there was no significant difference in the arthroscopic score between the two groups ( P>0.05), and the histological score of the isokinetic group was superior to the control group ( P<0.05).
Conclusion: On the basis of regular rehabilitation training, using the isokinetic training system to develop a suitable post-surgical isokinetic rehabilitation training program is helpful in early muscle strength recovery, early graft remodeling, and even long-term histological results after ACL reconstruction.
目的: 探讨大腿肌群等速训练对前交叉韧带（anterior cruciate ligament，ACL）重建术后移植物塑形的影响，总结规律以指导临床康复训练。.
方法: 选取 2016 年 8 月—12 月 40 例接受关节镜下自体腘绳肌腱单束重建 ACL 手术患者，根据术后功能锻炼方案分为试验组及对照组，每组 20 例。对照组常规康复锻炼，试验组在此基础上于术后 3～6 个月替换为大腿肌群等速训练。最终试验组 12 例、对照组 12 例获完整随访纳入研究。两组患者性别、年龄、体质量指数、损伤侧别、受伤至手术时间、术前国际膝关节文献委员会（IKDC）评分等一般资料比较，差异均无统计学意义（ P>0.05）。术后 3、6、12 个月及行二次关节镜手术（以下简称，二次镜检）时，行膝关节等速肌力测定，包括伸屈膝关节力矩峰值（peak torque，PT）以及腘绳肌与股四头肌肌力比值（hamstring quadriceps ratio，H/Q）；MRI 检查并行移植物评分。二次镜检时观察移植物外形、张力、血管化程度并评分，取样本行组织学观察并评分（血管分布、细胞形态）。.
结果: 试验组 ACL 重建术至二次镜检时间为（23.57±3.23）个月，对照组为（23.22±3.56）个月，差异无统计学意义（ P>0.05）。二次镜检时，试验组 IKDC 评分为（90.45±4.73）分，对照组为（89.32±4.54）分，均较术前明显提高（ P<0.05）；组间比较差异无统计学意义（ t=0.868， P=0.404）。膝关节等速肌力测定显示，术后 3 个月两组屈伸膝关节 PT 差异无统计学意义（ P>0.05），术后 6、12 个月以及二次镜检时试验组屈伸膝关节 PT 均大于对照组（ P<0.05）。两组术后 3 个月及二次镜检时 H/Q 差异无统计学意义（ P>0.05），试验组术后 6、12 个月时 H/Q 均大于对照组（ P<0.05）。术后 3、6 个月及二次镜检时两组 MRI 评分差异无统计学意义（ P>0.05），术后 12 个月试验组 MRI 评分明显高于对照组（ P<0.05）。二次镜下观测，试验组移植物评分与对照组比较差异无统计学意义（ P>0.05），但血管分布及细胞形态评分均高于对照组（ P<0.05）。.
结论: 在常规康复训练基础上，利用等速训练系统制定适宜的大腿肌群等速训练方案，有助于 ACL 重建术后早期肌力恢复、韧带早期塑形，甚至影响移植物远期组织学转归。.
Keywords: Anterior cruciate ligament reconstruction; isokinetic training; rehabilitation; remodeling.