干预措施旨在预防青少年和成年人前交叉韧带损伤：系统评价和荟萃分析。

Interventions designed to prevent anterior cruciate ligament injuries in adolescents and adults: a systematic review and meta-analysis.

机构信息

MedSport, Domino's Farms, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106-0391, USA.

出版信息

Am J Sports Med. 2013 Aug;41(8):1952-62. doi: 10.1177/0363546512458227. Epub 2012 Sep 12.

DOI:10.1177/0363546512458227

PMID:22972854

Abstract

BACKGROUND

Anterior cruciate ligament (ACL) injuries are common, result in significant morbidity, and are expensive to repair surgically and to rehabilitate. Several randomized and observational studies have tested neuromuscular interventions as preventive measures for these injuries.

PURPOSE

To conduct a systematic review and meta-analysis of all known comparative studies for estimating and testing the effect of neuromuscular and educational interventions on the incidence of ACL injuries in adolescents and adults, both male and female.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Several databases were used to identify eligible studies through July 4, 2011: MEDLINE, EMBASE, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials, and Health Technology Assessment. Eligible studies were assessed for risk of bias, and meta-analyses were performed on the estimated intervention effect (log incidence rate ratio) using inverse-variance weighting, subgroup analysis, and random-effects meta-regression to estimate the overall (pooled) effect and explore heterogeneity of effect across studies (measured by I2 and tested with the Q statistic).

RESULTS

Eight cohort (observational) studies and 6 randomized trials were included, involving a total of approximately 27,000 participants. The random-effects meta-analysis yielded a pooled rate-ratio estimate of 0.485 (95% confidence interval [CI], 0.299-0.788; P = .003), indicating a lower ACL rate in the intervention groups, but there was appreciable heterogeneity of the estimated effect across studies (I2 = 64%; P = .001). In the meta-regressions, the estimated effect was stronger for studies that were not randomized, performed in the United States, conducted in soccer players, had a longer duration of follow-up (more than 1 season), and had more hours of training per week in the intervention group, better compliance, and no dropouts. Nevertheless, residual heterogeneity was still observed within subgroups of those variables (I2 > 50%; P < .10).

CONCLUSION

The authors found that various types of neuromuscular and educational interventions appear to reduce the incidence rate of ACL injuries by approximately 50%, but the estimated effect varied appreciably among studies and was not able to explain most of that variability.

CLINICAL RELEVANCE

Neuromuscular and educational interventions appear to reduce the incidence rate of ACL injuries by approximately 50%.

摘要

背景

前交叉韧带（ACL）损伤很常见，会导致显著的发病率，并且手术修复和康复费用昂贵。几项随机和观察性研究已经测试了神经肌肉干预措施作为预防这些损伤的措施。

目的

对所有已知的比较研究进行系统回顾和荟萃分析，以估计和测试神经肌肉和教育干预措施对青少年和成年人（男性和女性）ACL 损伤发生率的影响。

研究设计

系统回顾和荟萃分析。

方法

使用多种数据库通过 2011 年 7 月 4 日识别合格研究：MEDLINE、EMBASE、SPORTDiscus、Cumulative Index to Nursing and Allied Health Literature、Cochrane 中央对照试验注册库和健康技术评估。对合格研究进行偏倚风险评估，并使用逆方差加权、亚组分析和随机效应荟萃回归对估计的干预效果（对数发病率比）进行荟萃分析，以估计总体（汇总）效果并探索研究之间的效果异质性（通过 I2 和 Q 统计量进行测试）。

结果

共纳入 8 项队列（观察性）研究和 6 项随机试验，共涉及约 27000 名参与者。随机效应荟萃分析得出的合并率比估计值为 0.485（95%置信区间 [CI]，0.299-0.788；P =.003），表明干预组的 ACL 发生率较低，但研究之间的估计效果存在明显的异质性（I2 = 64%；P =.001）。在荟萃回归中，对于未随机分组、在美国进行、在足球运动员中进行、随访时间超过 1 个赛季、干预组每周接受培训时间更长（超过 1 小时）、依从性更好且无脱落的研究，估计效果更强。然而，在这些变量的亚组中仍然观察到残留的异质性（I2 > 50%；P <.10）。