对于负重限制、膝关节支架的使用和后外侧角重建后重返运动的最佳康复目标和时间表，仍存在分歧

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-06-01 DOI:10.1016/j.asmr.2025.101142

Ilan Y. Mitchnik M.D. , Tomer Mimouni M.Sc. , Loren S. Haichin M.Sc. , Suzana Bayyouk B.P.T. , Gilbert Moatshe M.D. , Dror Lindner M.D. , Jorge Chahla M.D., Ph.D. , Yiftah Beer M.D. , Ron Gilat M.D.

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引用次数: 0

摘要

目的评估孤立性后外侧角（PLC）重建和合并前交叉韧带(ACL)/后交叉韧带（PCL）重建的康复方案的可变性，构建统一的康复方案建议，并为今后与PLC相关的临床研究提出康复效果指标。方法对在线PLC重建方案进行检索，将其分为孤立PLC重建方案和合并ACL/PCL重建方案。描述康复目标和时间表，并计算各方案的满意率。在2019年发表全球共识之前/之后，对各组之间和前后进行了比较。使用具有高一致性的共同康复目标来形成推荐方案。结果共分析了37个方案（分离PLC 19例，PLC + PCL 9例，PLC + ACL 9例）。总体而言，31%的康复目标和时间表具有良好至优秀的一致性。2019年后的共识是，对逐步康复方法的依从性显著提高，特别是在肌肉耐力训练后开始力量训练（P = 0.009）和力量训练后开始力量训练（P = 0.009）。031)。然而，总体协议率没有显著变化(P =。735)。大多数分歧涉及术后负重限制，一半的方案建议不负重，一半建议部分负重；6周后需要使用护膝的时间；和恢复运动时间，这与合并ACL（较晚恢复）和PCL（较早恢复）重建不同。结论对PLC重建后的负重限制、膝关节支架使用和重返运动的最佳康复目标和时间表存在分歧。确定了值得进一步研究的康复结果，并构建了建议的康复方案。PLC重建后的康复缺乏标准化，在负重、膝关节支撑和恢复运动时间等关键里程碑上存在显著差异。本研究分析了当前康复方案的不一致性，并提供了一个结构化的建议，可以帮助临床医生和物理治疗师进行患者咨询和方案制定。

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Disagreement Persists on Optimal Rehabilitation Goals and Timelines for Weight-Bearing Restriction, Knee Brace Use, and Return to Sports After Posterolateral Corner Reconstruction

Purpose

To assess the variability of rehabilitation protocols for both isolated posterolateral corner (PLC) reconstructions and those with a concomitant anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL) reconstruction, to construct uniform rehabilitative protocol recommendations, and to propose rehabilitative outcome measures for future PLC-related clinical studies.

Methods

A Google search was conducted for online PLC reconstruction rehabilitation protocols, categorizing them into isolated PLC reconstructions or PLC with concomitant ACL/PCL reconstructions. Rehabilitative goals and timelines were described and agreement rates among protocols were calculated. Comparisons were made between groups and before/after 2019, when a global consensus was published. Common rehabilitative goals with high agreement rates were used to form a recommended protocol.

Results

Thirty-seven protocols were analyzed (19 isolated PLC, 9 PLC + PCL, and 9 PLC + ACL). Overall, 31% of rehabilitative goals and timelines had good-to-excellent agreement rates. Post-2019 consensus, adherence to a stepwise rehabilitative approach significantly improved, especially for initiating strength exercises after muscular endurance exercises (P = .009) and initiating power exercises after strength exercises (P = . 031). However, there was no significant change in overall agreement rates (P = . 735). Most disagreements involved postoperative weight-bearing restrictions, with one half of protocols recommending non−weight-bearing and one half partial-weight-bearing; the period of time a knee brace is required after 6 weeks; and return to sports timing, which differed with concomitant ACL (later return) and PCL (earlier return) reconstructions.

Conclusions

There is disagreement about optimal rehabilitative goals and timelines for weight-bearing restriction, knee brace use, and return to sports after PLC reconstructions. Rehabilitative outcomes that warrant further research were identified, and a suggested rehabilitation protocol was constructed.

Clinical Relevance

Rehabilitation after PLC reconstruction lacks standardization, with significant variation in key milestones such as weight-bearing, knee bracing, and return-to-sport timelines. This study provides an analysis of current rehabilitation protocol inconsistencies and offers a structured recommendation that may assist clinicians and physiotherapists in patient counseling and protocol development.

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