Objective: To clarify the intervention guidance of return to sports WeChat applet and evaluate the rehabilitation effectiveness after anterior cruciate ligament (ACL) reconstruction.
Methods: Between September 2020 and September 2022, 80 patients who met the selection criteria and underwent ACL anatomical single bundle reconstruction were selected as the research objects. According to the double-blind random method, they were divided into the applet group and the regular group, with 40 cases in each group. Patients in the applet group were rehabilitated under the guidance of the return to sports WeChat applet, and the patients were asked to perform the test once a month after operation, including patients' subjective scores [Tegner score, knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee (IKDC) score, American Hospital for Special Surgery (HSS) score], psychological assessment [ACL recovery sports injury scale (ACL-RSI) score], jumping test, balance test, bending angle test. Patients in the regular group were followed up by doctors and nurses regularly by telephone every month. All the patients were reexamined at 3, 6, 9, and 12 months after operation, and the range of motion of the knee joint with 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, and internal and external displacement) recorded by Opti_Knee three-dimensional knee joint motion measurement gait analysis system was observed. The anterior tibial translation difference (ATTD) was measured by Ligs knee measuring instrument when a forward thrust of 120 N was applied to the posterior part of the proximal tibia. Tegner score, IKDC score, KOOS score (including KOOS-Pain score, KOOS-Symptoms score, KOOS-Activities of daily living score, KOOS-Sport score, and KOOS-Quality of life score), HSS score, ACL-RSI score, jumping ability, balance ability, patients' satisfaction with the rehabilitation process, and ACL healing grading according to ACL continuity and signal intensity shown by MRI.
Results: There were significant differences in various indicators between different time points after operation in the two groups ( P<0.05). At 3 months after operation, except that the ACL-RSI score of the applet group was significantly higher than that of the regular group ( P<0.05), there was no significant difference in the other indicators between the two groups ( P>0.05). At 6 months after operation, the ACL-RSI score, IKDC score, Tegner score, KOOS scores of different items, HSS score, balance and jumping ability of the applet group were significantly higher than those of the regular group ( P<0.05), and there was no significant difference in the other indicators between the two groups ( P>0.05). At 9 months after operation, there was no significant difference in all indicators between the two groups ( P>0.05). At 12 months after operation, 27 cases (67.5%) in the applet group and 21 cases (52.5%) in the regular group returned to sport, with a significant difference of the return to sports incidence between the two groups [ RR(95% CI)=1.50 (1.00, 2.25), P=0.049]. In the applet group, 27 cases were very satisfied with the rehabilitation process, 10 cases were satisfied, 2 cases were basically satisfied, and 1 case was not satisfied, while 19, 13, 5, and 3 cases in the regular group, respectively. The satisfaction degree of the applet group was significantly better than that of the regular group ( P=0.049). MRI examination of the two groups showed that the ACL was continuous without secondary rupture or necrosis. The ACL healing grade of the applet group was 31 cases of grade 1 and 9 cases of grade 2, and that of the regular group was 28 cases of grade 1 and 12 cases of grade 2, there was no significant difference in ACL healing grade between the two groups ( P=0.449).
Conclusion: The application of return to sports WeChat applet in the rehabilitation of patients after ACL reconstruction can significantly reduce the fear of return to sports and improve the rate of return to sports. The return to sports WeChat applet is convenient to operate, with high utilization rate and high patient compliance, which significantly improves the satisfaction.
目的: 探讨重返运动微信小程序干预指导并评估前交叉韧带（anterior cruciate ligament，ACL）重建术后康复锻炼的疗效。.
方法: 选取2020年9月—2022年9月符合选择标准的80例行ACL解剖单束重建患者为研究对象，按双盲随机法分为小程序组和常规组，每组40例。小程序组患者在重返运动微信小程序指导下进行康复，术后每月进行1次测试，包括患者主观评分 ［膝关节运动水平Tegner评分、膝关节损伤与骨关节炎结果（KOOS）评分、国际膝关节文献委员会（IKDC）评分、美国特种外科医院（HSS）评分］、心理评估 ［ACL恢复运动损伤量表（ACL-RSI）评分］、跳跃测试、平衡测试、弯曲角度测试；常规组由医师及护士每月定期对患者行电话随访。两组患者于术后3、6、9、12个月复查，观测指标包括：Opti_Knee膝关节三维运动测量步态分析系统记录的膝关节6个自由度（屈伸角、内外翻角、内外旋角、前后位移、上下位移及内外位移）活动范围，Ligs关节韧带数字体查仪测量对胫骨近端后方施加前向推力120 N时患者的胫骨前向位移差异（anterior tibial translation difference，ATTD），Tegner评分、IKDC评分、KOOS评分（包括疼痛、症状、日常生活、体育娱乐、生活质量5项评分）、HSS评分、ACL-RSI评分，跳跃能力和平衡能力，患者对康复过程满意程度，以及根据MRI显示的ACL连续性和信号强度进行ACL愈合分级。.
结果: 两组患者各指标术后各时间点间差异均有统计学意义（ P<0.05）。术后3个月，除小程序组ACL-RSI评分高于常规组（ P<0.05）外，其余指标两组间比较差异均无统计学意义（ P>0.05）。术后6个月，小程序组ACL-RSI评分、IKDC评分、Tegner评分、KOOS各项评分、HSS评分及平衡和跳跃能力均高于常规组（ P<0.05），其余指标两组间比较差异均无统计学意义（ P>0.05）。术后9个月，两组间各指标差异均无统计学意义（ P>0.05）。术后12个月，小程序组重返运动达标27例（67.5%），常规组21例（52.5%），两组重返运动率差异有统计学意义 ［ RR（95% CI）=1.50（1.00，2.25）， P=0.049］。小程序组对康复过程非常满意27例、满意10例、基本满意2例、不满意1例，常规组分别为19、13、5、3例，小程序组满意程度优于常规组（ P=0.049）。两组患者MRI检查均可见ACL走行连续，无二次断裂及坏死，其中小程序组ACL愈合分级达1级31例、2级9例，常规组1级28例、2级12例，两组ACL愈合分级比较差异无统计学意义（ P=0.449）。.
结论: 应用重返运动小程序干预指导ACL重建术后康复可显著减轻患者对重返运动的恐惧心理，提高术后重返运动率；且该小程序操作便捷、使用率高、患者依从性高，满意度明显提升。.
Keywords: Anterior cruciate ligament reconstruction; WeChat applet; postoperative rehabilitation; return to sport.