Mayer Stephanie W, Queen Robin M, Taylor Dean, Moorman Claude T, Toth Allison P, Garrett William E, Butler Robert J
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA Michael W. Krzyzewski Human Performance Research Laboratory, Duke University Medical Center, Durham, North Carolina, USA
Am J Sports Med. 2015 Jul;43(7):1648-55. doi: 10.1177/0363546515578249. Epub 2015 Apr 13.
No standardized return-to-activity or sport guidelines currently exist after anterior cruciate ligament (ACL) reconstruction. Isokinetic testing and unilateral hop testing, which have construct validity, are often used to make the determination of when a patient is ready to return to sport. Neither of these measures has been reported to be predictive of subsequent injuries.
To compare the performance on 2 functional tests of ACL reconstruction patients released to return to activity versus those who have not been released based on clinical impairment measures.
Cohort study; Level of evidence, 3.
A total of 98 patients were examined by the treating orthopaedic surgeon 6 months after ACL reconstruction for traditional impairment measures, including swelling, range of motion, strength, and graft stability. After this examination, all subjects completed the functional testing, consisting of the Functional Movement Screen (FMS) and the Lower Quarter Y Balance Test (YBT-LQ), by an experienced tester who was blinded to the results of the clinical examination. On the basis of the clinical examination, all patients were grouped as being ready to return to sport or not being ready. Performance on the functional tests, as measured by overall performance and side-to-side asymmetry, was compared between the 2 groups using independent-samples t tests (P < .05).
No difference existed between the groups with regard to the descriptive characteristics, with the exception that the group not cleared was younger (21.0 ± 7.4 years) than the group that was cleared (25.6 ± 13.2 years). Performance on the YBT-LQ revealed that no differences existed between groups when examining reach symmetry for any of the reach directions. In addition, no differences were found between groups when looking at the average reach score normalized to limb length for either the surgical or nonsurgical leg. Patients in the cleared group exhibited a similar score on the FMS (12.7 ± 2.9) compared with the noncleared group (12.8 ± 2.7). Similarly, no differences were observed for the number of asymmetries; however, both groups averaged 1 asymmetry during the testing.
Clinical impairment measures do not appear to be related to measured functional ability. Performance on both functional tests, the FMS and YBT-LQ, at 6 months would suggest that the typical patient in both groups would be at a greater risk of lower extremity injury, based on currently published research.
目前，前交叉韧带（ACL）重建术后尚无标准化的恢复活动或运动指南。具有结构效度的等速测试和单腿跳测试常被用于确定患者何时准备好恢复运动。但尚无报道称这些测试能预测后续损伤。
比较根据临床损伤指标判定可以恢复活动的ACL重建患者与尚未获准恢复活动的患者在两项功能测试中的表现。
队列研究；证据等级，3级。
98例患者在ACL重建术后6个月接受主刀骨科医生检查，评估传统损伤指标，包括肿胀、活动范围、力量和移植物稳定性。此次检查后，所有受试者由一名对临床检查结果不知情的经验丰富的测试人员完成功能测试，包括功能性动作筛查（FMS）和下半身Y平衡测试（YBT-LQ）。根据临床检查结果，将所有患者分为准备好恢复运动和未准备好恢复运动两组。使用独立样本t检验比较两组在功能测试中的表现（以整体表现和双侧不对称性衡量）（P <.05）。
两组在描述性特征方面无差异，唯一例外是未获准恢复运动的组（21.0±7.4岁）比获准恢复运动的组（25.6±13.2岁）更年轻。YBT-LQ测试结果显示，在检查任何一个伸展方向的伸展对称性时，两组之间没有差异。此外，在查看手术侧或非手术侧腿的平均伸展得分与肢体长度的标准化比值时，两组之间也没有差异。获准恢复运动组患者在FMS测试中的得分（12.7±2.9）与未获准恢复运动组（12.8±2.7）相似。同样，在不对称数量方面未观察到差异；然而，两组在测试期间平均有1项不对称。
临床损伤指标似乎与测量的功能能力无关。根据目前发表的研究，在术后6个月时进行的FMS和YBT-LQ这两项功能测试结果表明，两组中的典型患者下肢受伤风险都更高。
