膝前十字靭帯再建術後3 ヶ月の膝関節伸展可動域に影響を及ぼす因子 術後早期の運動恐怖感と膝関節機能の関連性を合わせた検討
膝前十字靭帯（以下：ACL）再建術後3 ヶ月の膝関節伸展可動域制限に影響する因子を，術後1 ヶ月の膝関節機能と運動恐怖感の有無から検討した．対象はSTG(semitendinosus and gracilis tendons)法にてACL 再建術を施行された患者35 名とした．除外基準はACL 再建術の既往を有する者，ACL 再建術と同時に複合靭帯再建術を行った者，術後膝関節伸展可動域制限を設けられた者とした．術後1 ヶ月では膝関節伸展可動域（HHD:Heel height difference）・安静時痛・歩行時痛・立ち上がりテスト・運動恐怖感の有無，術後3 ヶ月では膝関節伸展可動域(HHD...
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| Published in | 保健医療学雑誌 Vol. 12; no. 2; pp. 98 - 105 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
保健医療学学会
01.10.2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 2185-0399 |
| DOI | 10.15563/jalliedhealthsci.12.98 |
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| Abstract | 膝前十字靭帯（以下：ACL）再建術後3 ヶ月の膝関節伸展可動域制限に影響する因子を，術後1 ヶ月の膝関節機能と運動恐怖感の有無から検討した．対象はSTG(semitendinosus and gracilis tendons)法にてACL 再建術を施行された患者35 名とした．除外基準はACL 再建術の既往を有する者，ACL 再建術と同時に複合靭帯再建術を行った者，術後膝関節伸展可動域制限を設けられた者とした．術後1 ヶ月では膝関節伸展可動域（HHD:Heel height difference）・安静時痛・歩行時痛・立ち上がりテスト・運動恐怖感の有無，術後3 ヶ月では膝関節伸展可動域(HHD)を評価した．統計学的解析は，術後3 ヶ月の膝関節伸展可動域と術後1 ヶ月の各項目との相関関係を検討した．有意な相関関係を認めた変数は重回帰分析を行った．また，運動恐怖感の有無と膝関節機能との相関関係を検討した．本研究結果より術後3 ヶ月のHHD は術後1 ヶ月のHHD および歩行時痛と有意な相関関係を認め，運動恐怖感あり群において術後1 か月の安静時痛が強かった．ACL 再建術後3 ヶ月の膝関節伸展可動域獲得に向けて，術後早期から膝関節伸展可動域を獲得することが重要であることが示唆された．また，術後1 ヶ月後の運動恐怖感は3 ヶ月後の膝関節伸展可動域に直接的には影響しないが，安静時痛を増大させる一要因であることが明らかとなった．術後1 ヶ月の安静時痛を軽減させるためには，運動恐怖感の軽減を目的とした介入が必要である． |
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| AbstractList | 膝前十字靭帯（以下：ACL）再建術後3 ヶ月の膝関節伸展可動域制限に影響する因子を，術後1 ヶ月の膝関節機能と運動恐怖感の有無から検討した．対象はSTG(semitendinosus and gracilis tendons)法にてACL 再建術を施行された患者35 名とした．除外基準はACL 再建術の既往を有する者，ACL 再建術と同時に複合靭帯再建術を行った者，術後膝関節伸展可動域制限を設けられた者とした．術後1 ヶ月では膝関節伸展可動域（HHD:Heel height difference）・安静時痛・歩行時痛・立ち上がりテスト・運動恐怖感の有無，術後3 ヶ月では膝関節伸展可動域(HHD)を評価した．統計学的解析は，術後3 ヶ月の膝関節伸展可動域と術後1 ヶ月の各項目との相関関係を検討した．有意な相関関係を認めた変数は重回帰分析を行った．また，運動恐怖感の有無と膝関節機能との相関関係を検討した．本研究結果より術後3 ヶ月のHHD は術後1 ヶ月のHHD および歩行時痛と有意な相関関係を認め，運動恐怖感あり群において術後1 か月の安静時痛が強かった．ACL 再建術後3 ヶ月の膝関節伸展可動域獲得に向けて，術後早期から膝関節伸展可動域を獲得することが重要であることが示唆された．また，術後1 ヶ月後の運動恐怖感は3 ヶ月後の膝関節伸展可動域に直接的には影響しないが，安静時痛を増大させる一要因であることが明らかとなった．術後1 ヶ月の安静時痛を軽減させるためには，運動恐怖感の軽減を目的とした介入が必要である． |
| Author | 森, 一晃 山内, 大士 岡, 智大 伊佐次, 優一 三木, 貴弘 |
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| References | 16 Butler DL,Noyes FR,Grood ES: Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am62:259-270,1980 36 Beynnon BD,Johnson RJ,Fleming BC,et al.: Anterior cruciate ligament replacement: state of the art. Pain 85:317‒332,2000 comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg AM 84:1503-1513,2002 8 Yazdi H,Moradi A,Sanaie A,et al.: Does the hyperextension maneuver prevent knee 6,2015 extension loss after arthroscopic anterior cruciate ligament reconstruction? J Orthop Traumatol 17:327-331,2016 34 Comachio J,Magalhaes MO,Marques AP,et al.: A cross-sectional study of associations between kinesiophobia,pain,disability,and quality of life in patients with chronic low back pain. Adv Rheumatol58:8,2018 33 Leuuw M,Goossens ME,Linton SJ,et al.: The fear-avoidance model of musculoskeletal pain: J phys Rehabili Med 51:155-161,2015 current state of scientific evidence. J Behav Med 30:77-94,2007 19 Schlegel TF,Boublik M,HawkinsRJ,et al.: Reliability of heel-height measurement for documenting knee extension deficits. Am J Sports Med 30:479-482,2002 3 de Jong SN,van Caspel DR,van Haeff MJ,et al.: Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthoroscopy 23:21-28,2007 11 堀江雅史，古賀英之，宗田大・他：ACL 再建術後のスポーツ復帰期間・パフォーマンスへ影響を与える因子の検討．日本整形外科学会雑誌88：607，2014 12 Rambaud AJM,Ardern CL,Thoreux P,et al.: Criteria for return to running after anterior 6072014cruciate ligament reconstruction: a scoping review. Br J Sports Med 52:1437-1444,2018 1 Splinder KP,Kuhn JE,Freedman KB,et al.: Anterior cruciate ligament reconstrucution auto graft choice: bone-tendon-bone versus hamstrings,does it really matter ? A systematic review.Am J Sports Med 32:1986-1995,2012 32 Doury F,Metivier JC,Fouquet B,et al.: Kinesiophobia negatively influences recovery of J Electromyogr Kinesiol 20:684-692,2010 joint function following total knee arthroplasty. J phys Rehabili Med 51:155-161,2015 13 J. Kartus,Lennart Magnusson,Sven Stener,et al.: Complications following arthroscopic review. Br J Sports Med 52:1437-1444,2018 anterior cruciate ligament reconstruction A 2-5- year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc7:2-8,1998 15 Chmielewski TL,Jones D,Day T,et al.: The association of pain and fear of reconstruction. Clin J Pain 28:73-80,2012 movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation. J Orthop Sports Phys Ther 38:746-753,2008 14 George SZ,Lentz TA,Zeppieri G, et al.: Analysis of shortened versions of the tampa scale for Sports Traumatol Arthrosc7:2-8,1998 kinesiophobia and pain catastrophizing scale for patients after anterior cruciate ligament reconstruction. Clin J Pain 28:73-80,2012 9 Sachs RA,Daniel DM,Stone ML,et al.: Traumatol 17:327-331,2016 Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17:760-765,1989 27 安田一平，熊崎大輔，大工谷新一：台の高さを変える立ち上がりテストによる膝関節の伸展筋力評 価について．関西理学11：47-50，2011 21 米本恭三，石上重信，近藤徹：関節可動域表示ならびに測定法．リハビリテーション医学32：207- 217，1995 22 Langley GB,Sheppeard H: The visual analogue scale: Its use in pain measurement. Rheumatol Int 5:145-148,1985 26 鈴川仁人，玉置龍也，木村佑：膝前十字靭帯損傷の機能解剖学的病態把握と理学療法．理学療法 29：161-174，2012 28 Muraki S,Akune T,Teraguchi M,et al:Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain: the ROAD study. BMC Musculoskeletal Disorders 16:305,2015 6 中山寛，山口基，吉矢晋一・他：前十字靭帯再建術後の膝伸展制限の変化，JOSKAS35：112- 113，2010 5 Agletti P,Buzzi RD,Andria S,et al.: Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction.Clin Orthop Relat Res 288:195-204,1993 23 山本利春，村永信吾：下肢筋力が簡便に推定可能な立ち上がり能力の評価．Sportsmedicine 41： 38-40，2002 31 Hemsley k,Sitler M,Moyer R,et al.: Neuromuscular and psychological influences on range of motion recovery in anterior cruciate ligament reconstruction patients.J Electromyogr Kinesiol 20:684-692,2010 29 Hartigen EH,Lynch AD,Logerstedt DS, et al.: Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther.43:821-832,2013 35 Vlaeyen JW, Linton SJ: Fear-avoidance and its consequences in chronic musculoskeletal pain: a Rheumatol58:8,2018 state of the art. Pain 85:317‒332,2000 17 Sakane M,Fox RJ,Woo SL, et al.: In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res15:285-293,1997 30 Chmielewski TL,George SZ: Fear avoidance and self-efficacy at 4 weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation. Knee Surg Sports Traumatol Arthrosc27:397-404,2019 10 Shelbourne KD,Urch SE,Gray T, et al.: Loss of normal knee motion after anterior cruciate 17:760-765,1989 ligament reconstruction is associated with radio graphic change after surgery. Am J Sports Med40:108-113, 2012 18 Andriacchi TP,Alexander EJ,Toney MK, et al.: A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J Buomech Eng120:743-749,1998 2 Yagi M,Kuroda R,Nagamune K,et al.: Double bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100-107,2007 20 Schlegal TF,Boublick M,Richard RJ,et al:Reliability of heel-height measurement for documenting knee extension deficits. Am J Sports Med 30:479-482,2002 25 松平浩，犬塚恭子，菊池徳昌：日本語Tampa Scale for Kinesiophobia(TSK-J)の開発言語的妥当 性を担保した翻訳版の作成．臨床整形外科48：13-19，2013 24 Kikuchi N,Matsudaira K,Sawada T, et al.: Psychometric properties of the Japanese version of the Tampa Scale for Kinesiophobia (TSK-J) in patients with whiplash neck injury pain and/or low back pain. J orthop Sci 20:985-992,2015 4 Paulos LE,Rosenberg TD,Drawbert J,et al.: Infraptellar contracture syndrome.An unrecognized cause of knee stiffness with patellainferia. AMJ sports MED15:331-341,1987 7 Noll S,Garrison JC,Bothwell J,et al.: Knee Extension Range of Motion at 4 Weeks Is 1132010 Related to Knee Extension Loss at 12 Weeks After Anterior Cruciate Ligament Reconstruction.The Orthop J Sports Med 3:1- 6,2015 |
| References_xml | – reference: 27 安田一平，熊崎大輔，大工谷新一：台の高さを変える立ち上がりテストによる膝関節の伸展筋力評 価について．関西理学11：47-50，2011 – reference: 26 鈴川仁人，玉置龍也，木村佑：膝前十字靭帯損傷の機能解剖学的病態把握と理学療法．理学療法 29：161-174，2012 – reference: 4 Paulos LE,Rosenberg TD,Drawbert J,et al.: Infraptellar contracture syndrome.An unrecognized cause of knee stiffness with patellainferia. AMJ sports MED15:331-341,1987 – reference: 34 Comachio J,Magalhaes MO,Marques AP,et al.: A cross-sectional study of associations between kinesiophobia,pain,disability,and quality of life in patients with chronic low back pain. Adv Rheumatol58:8,2018 – reference: 6 中山寛，山口基，吉矢晋一・他：前十字靭帯再建術後の膝伸展制限の変化，JOSKAS35：112- 113，2010 – reference: 11 堀江雅史，古賀英之，宗田大・他：ACL 再建術後のスポーツ復帰期間・パフォーマンスへ影響を与える因子の検討．日本整形外科学会雑誌88：607，2014 – reference: 22 Langley GB,Sheppeard H: The visual analogue scale: Its use in pain measurement. Rheumatol Int 5:145-148,1985 – reference: 9 Sachs RA,Daniel DM,Stone ML,et al.: Traumatol 17:327-331,2016 Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17:760-765,1989 – reference: 16 Butler DL,Noyes FR,Grood ES: Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am62:259-270,1980 – reference: 28 Muraki S,Akune T,Teraguchi M,et al:Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain: the ROAD study. BMC Musculoskeletal Disorders 16:305,2015 – reference: 33 Leuuw M,Goossens ME,Linton SJ,et al.: The fear-avoidance model of musculoskeletal pain: J phys Rehabili Med 51:155-161,2015 current state of scientific evidence. J Behav Med 30:77-94,2007 – reference: 36 Beynnon BD,Johnson RJ,Fleming BC,et al.: Anterior cruciate ligament replacement: state of the art. Pain 85:317‒332,2000 comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg AM 84:1503-1513,2002 – reference: 31 Hemsley k,Sitler M,Moyer R,et al.: Neuromuscular and psychological influences on range of motion recovery in anterior cruciate ligament reconstruction patients.J Electromyogr Kinesiol 20:684-692,2010 – reference: 15 Chmielewski TL,Jones D,Day T,et al.: The association of pain and fear of reconstruction. Clin J Pain 28:73-80,2012 movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation. J Orthop Sports Phys Ther 38:746-753,2008 – reference: 29 Hartigen EH,Lynch AD,Logerstedt DS, et al.: Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. J Orthop Sports Phys Ther.43:821-832,2013 – reference: 3 de Jong SN,van Caspel DR,van Haeff MJ,et al.: Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthoroscopy 23:21-28,2007 – reference: 1 Splinder KP,Kuhn JE,Freedman KB,et al.: Anterior cruciate ligament reconstrucution auto graft choice: bone-tendon-bone versus hamstrings,does it really matter ? A systematic review.Am J Sports Med 32:1986-1995,2012 – reference: 5 Agletti P,Buzzi RD,Andria S,et al.: Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction.Clin Orthop Relat Res 288:195-204,1993 – reference: 8 Yazdi H,Moradi A,Sanaie A,et al.: Does the hyperextension maneuver prevent knee 6,2015 extension loss after arthroscopic anterior cruciate ligament reconstruction? J Orthop Traumatol 17:327-331,2016 – reference: 13 J. Kartus,Lennart Magnusson,Sven Stener,et al.: Complications following arthroscopic review. Br J Sports Med 52:1437-1444,2018 anterior cruciate ligament reconstruction A 2-5- year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc7:2-8,1998 – reference: 19 Schlegel TF,Boublik M,HawkinsRJ,et al.: Reliability of heel-height measurement for documenting knee extension deficits. Am J Sports Med 30:479-482,2002 – reference: 25 松平浩，犬塚恭子，菊池徳昌：日本語Tampa Scale for Kinesiophobia(TSK-J)の開発言語的妥当 性を担保した翻訳版の作成．臨床整形外科48：13-19，2013 – reference: 7 Noll S,Garrison JC,Bothwell J,et al.: Knee Extension Range of Motion at 4 Weeks Is 1132010 Related to Knee Extension Loss at 12 Weeks After Anterior Cruciate Ligament Reconstruction.The Orthop J Sports Med 3:1- 6,2015 – reference: 18 Andriacchi TP,Alexander EJ,Toney MK, et al.: A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J Buomech Eng120:743-749,1998 – reference: 10 Shelbourne KD,Urch SE,Gray T, et al.: Loss of normal knee motion after anterior cruciate 17:760-765,1989 ligament reconstruction is associated with radio graphic change after surgery. Am J Sports Med40:108-113, 2012 – reference: 2 Yagi M,Kuroda R,Nagamune K,et al.: Double bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100-107,2007 – reference: 20 Schlegal TF,Boublick M,Richard RJ,et al:Reliability of heel-height measurement for documenting knee extension deficits. Am J Sports Med 30:479-482,2002 – reference: 32 Doury F,Metivier JC,Fouquet B,et al.: Kinesiophobia negatively influences recovery of J Electromyogr Kinesiol 20:684-692,2010 joint function following total knee arthroplasty. J phys Rehabili Med 51:155-161,2015 – reference: 12 Rambaud AJM,Ardern CL,Thoreux P,et al.: Criteria for return to running after anterior 6072014cruciate ligament reconstruction: a scoping review. Br J Sports Med 52:1437-1444,2018 – reference: 24 Kikuchi N,Matsudaira K,Sawada T, et al.: Psychometric properties of the Japanese version of the Tampa Scale for Kinesiophobia (TSK-J) in patients with whiplash neck injury pain and/or low back pain. J orthop Sci 20:985-992,2015 – reference: 23 山本利春，村永信吾：下肢筋力が簡便に推定可能な立ち上がり能力の評価．Sportsmedicine 41： 38-40，2002 – reference: 35 Vlaeyen JW, Linton SJ: Fear-avoidance and its consequences in chronic musculoskeletal pain: a Rheumatol58:8,2018 state of the art. Pain 85:317‒332,2000 – reference: 14 George SZ,Lentz TA,Zeppieri G, et al.: Analysis of shortened versions of the tampa scale for Sports Traumatol Arthrosc7:2-8,1998 kinesiophobia and pain catastrophizing scale for patients after anterior cruciate ligament reconstruction. Clin J Pain 28:73-80,2012 – reference: 17 Sakane M,Fox RJ,Woo SL, et al.: In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res15:285-293,1997 – reference: 21 米本恭三，石上重信，近藤徹：関節可動域表示ならびに測定法．リハビリテーション医学32：207- 217，1995 – reference: 30 Chmielewski TL,George SZ: Fear avoidance and self-efficacy at 4 weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation. Knee Surg Sports Traumatol Arthrosc27:397-404,2019) |
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| Snippet | 膝前十字靭帯（以下：ACL）再建術後3 ヶ月の膝関節伸展可動域制限に影響する因子を，術後1 ヶ月の膝関節機能と運動恐怖感の有無から検討した．対象はSTG(semitendinosus... |
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| SubjectTerms | 膝前十字靭帯再建術 膝関節伸展可動域 運動恐怖感 |
| Subtitle | 術後早期の運動恐怖感と膝関節機能の関連性を合わせた検討 |
| Title | 膝前十字靭帯再建術後3 ヶ月の膝関節伸展可動域に影響を及ぼす因子 |
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| ispartofPNX | 保健医療学雑誌, 2021/10/01, Vol.12(2), pp.98-105 |
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