Grimm Nathan L, Jacobs John C, Kim Jaewhan, Denney Brandon S, Shea Kevin G
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
University of Utah School of Medicine, Salt Lake City, Utah, USA.
Am J Sports Med. 2015 Aug;43(8):2049-56. doi: 10.1177/0363546514556737. Epub 2014 Dec 1.
BACKGROUND: Soccer has one of the highest incidences of anterior cruciate ligament (ACL) injuries for both males and females. Several injury prevention programs have been developed to address this concern. However, an analysis of the pooled effect has yet to be elicited. PURPOSE: To conduct a systematic review and meta-analysis of ACL and knee injury prevention programs for soccer players, assess the heterogeneity among the studies, and evaluate the reported effectiveness of the prevention programs. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic search of the literature was conducted on PubMed (Medline), Embase, CINAHL, and Central-Cochrane Database. Studies were limited to randomized controlled trials (RCTs) of injury prevention programs specific to the knee and/or ACL in soccer players. The Cochrane Q test and I (2) index were independently used to assess heterogeneity among the studies. The pooled risk difference, assessing knee and/or ACL injury rates between intervention and control groups, was calculated by random-effects models with use of the DerSimonian-Laird method. Publication bias was assessed with a funnel plot and Egger weighted regression technique. RESULTS: Nine studies met the inclusion criteria as RCTs. A total of 11,562 athletes were included, of whom 7889 were analyzed for ACL-specific injuries. Moderate heterogeneity was found among studies of knee injury prevention (P = .041); however, there was insignificant variation found among studies of ACL injury prevention programs (P = .222). For studies of knee injury prevention programs, the risk ratio was 0.74 (95% CI, 0.55-0.89), and a significant reduction in risk of knee injury was found in the prevention group (P = .039). For studies of ACL injury prevention programs, the risk ratio was 0.66 (95% CI, 0.33-1.32), and a nonsignificant reduction in risk of ACL injury was found in the prevention group (P = .238). No evidence of publication bias was found among studies of either knee or ACL injury prevention programs. CONCLUSION: This systematic review and meta-analysis of ACL and knee injury prevention program studies found a statistically significant reduction in injury risk for knee injuries but did not find a statistically significant reduction of ACL injuries.
背景：足球运动中，男性和女性前交叉韧带（ACL）损伤的发生率均处于较高水平。为解决这一问题，已制定了多项损伤预防计划。然而，尚未对这些计划的综合效果进行分析。 目的：对足球运动员ACL及膝关节损伤预防计划进行系统评价和荟萃分析，评估各研究之间的异质性，并评价所报道的预防计划的有效性。 研究设计：系统评价和荟萃分析。 方法：在PubMed（Medline）、Embase、CINAHL和Cochrane Central数据库中对文献进行系统检索。研究仅限于针对足球运动员膝关节和/或ACL的损伤预防计划的随机对照试验（RCT）。独立使用Cochrane Q检验和I²指数评估各研究之间的异质性。采用DerSimonian-Laird方法，通过随机效应模型计算汇总风险差异，以评估干预组和对照组之间膝关节和/或ACL损伤率。采用漏斗图和Egger加权回归技术评估发表偏倚。 结果：9项研究符合RCT纳入标准。共纳入11562名运动员，其中7889名运动员被分析ACL特异性损伤情况。在膝关节损伤预防研究中发现中度异质性（P = 0.041）；然而，在ACL损伤预防计划研究中未发现显著差异（P = 0.222）。对于膝关节损伤预防计划的研究，风险比为0.74（95%CI，0.55 - 0.89），预防组膝关节损伤风险显著降低（P = 0.039）。对于ACL损伤预防计划的研究，风险比为0.66（95%CI，0.33 - 1.32），预防组ACL损伤风险降低不显著（P = 0.238）。在膝关节或ACL损伤预防计划的研究中均未发现发表偏倚的证据。 结论：这项对ACL和膝关节损伤预防计划研究的系统评价和荟萃分析发现，膝关节损伤风险在统计学上有显著降低，但ACL损伤在统计学上未发现显著降低。
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