Pacey Verity, Nicholson Leslie L, Adams Roger D, Munn Joanne, Munns Craig F
Sports Physiotherapy Physiotherapy Department, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
Am J Sports Med. 2010 Jul;38(7):1487-97. doi: 10.1177/0363546510364838.
Generalized joint hypermobility is a highly prevalent condition commonly associated with joint injuries. The current literature has conflicting reports of the risk of joint injury in hypermobile sporting participants compared with their nonhypermobile peers. Systematic reviews have not been conclusive and no meta-analysis has been performed.
This review was undertaken to determine whether individuals with generalized joint hypermobility have an increased risk of lower limb joint injury when undertaking sporting activities.
Systematic review with meta-analysis.
Studies were identified through a search without language restrictions of PubMed, CINAHL, Embase, and SportDiscus databases from the earliest date through February 2009 with subsequent handsearching of reference lists. Inclusion criteria for studies were determined before searching and all included studies underwent methodological quality assessment by 2 independent reviewers. Meta-analyses for joint injury of the lower limb, knee, and ankle were performed using a random effects model. The difference in injury proportions between hypermobility categories was tested with the z statistic.
Of 4841 identified studies, 18 met all inclusion criteria with methodological quality ranging from 1 of 6 to 5 of 6. A variety of tests of hypermobility and varied cutoff points to define the presence of generalized joint hypermobility were used, so the authors determined a standardized cutoff to indicate generalized joint hypermobility. Using this criterion, a significantly increased risk of knee joint injury for hypermobile and extremely hypermobile participants compared with their nonhypermobile peers was demonstrated (P < .001), whereas no increased risk was found for ankle joint injury. For knee joint injury, a combined odds ratio of 4.69 (95% confidence interval, 1.33-16.52; P = .02) was calculated, indicating a significantly increased risk for hypermobile participants playing contact sports.
Sport participants with generalized joint hypermobility have an increased risk of knee joint injury during contact activities but have no altered risk of ankle joint injury.
全身关节活动过度是一种非常普遍的状况，通常与关节损伤相关。目前的文献对于关节活动过度的运动员与非关节活动过度的同龄人相比，其关节损伤风险的报道相互矛盾。系统评价尚无定论，也未进行荟萃分析。
本综述旨在确定全身关节活动过度的个体在进行体育活动时下肢关节损伤风险是否增加。
系统评价与荟萃分析。
通过检索PubMed、CINAHL、Embase和SportDiscus数据库（检索无语言限制，始于最早日期至2009年2月），并随后手工检索参考文献列表来识别研究。在检索前确定研究的纳入标准，所有纳入研究由2名独立评审员进行方法学质量评估。使用随机效应模型对下肢、膝关节和踝关节的关节损伤进行荟萃分析。用z统计量检验关节活动过度类别之间损伤比例的差异。
在4841项已识别的研究中，18项符合所有纳入标准，方法学质量从6分中的1分到6分中的5分不等。使用了多种关节活动过度测试和不同的切点来定义全身关节活动过度的存在，因此作者确定了一个标准化切点来指示全身关节活动过度。使用该标准，与非关节活动过度的同龄人相比，关节活动过度和极度关节活动过度的参与者膝关节损伤风险显著增加（P <.001），而踝关节损伤风险未增加。对于膝关节损伤，计算出合并比值比为4.69（95%置信区间，1.33 - 16.52；P =.02），表明关节活动过度的参与者进行接触性运动时损伤风险显著增加。
全身关节活动过度的体育参与者在接触性活动期间膝关节损伤风险增加，但踝关节损伤风险未改变。
