Onate James A, Everhart Joshua S, Clifton Daniel R, Best Thomas M, Borchers James R, Chaudhari Ajit M W
*Division of Athletic Training, The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio; †Family Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio; ‡Sports Health and Performance Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; and §Division of Physical Therapy, The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio.
Clin J Sport Med. 2016 Nov;26(6):435-444. doi: 10.1097/JSM.0000000000000284.
A stated goal of the preparticipation physical evaluation (PPE) is to reduce musculoskeletal injury, yet the musculoskeletal portion of the PPE is reportedly of questionable use in assessing lower extremity injury risk in high school-aged athletes. The objectives of this study are: (1) identify clinical assessment tools demonstrated to effectively determine lower extremity injury risk in a prospective setting, and (2) critically assess the methodological quality of prospective lower extremity risk assessment studies that use these tools.
A systematic search was performed in PubMed, CINAHL, UptoDate, Google Scholar, Cochrane Reviews, and SportDiscus. Inclusion criteria were prospective injury risk assessment studies involving athletes primarily ages 13 to 19 that used screening methods that did not require highly specialized equipment. Methodological quality was evaluated with a modified physiotherapy evidence database (PEDro) scale.
Nine studies were included. The mean modified PEDro score was 6.0/10 (SD, 1.5). Multidirectional balance (odds ratio [OR], 3.0; CI, 1.5-6.1; P < 0.05) and physical maturation status (P < 0.05) were predictive of overall injury risk, knee hyperextension was predictive of anterior cruciate ligament injury (OR, 5.0; CI, 1.2-18.4; P < 0.05), hip external:internal rotator strength ratio of patellofemoral pain syndrome (P = 0.02), and foot posture index of ankle sprain (r = -0.339, P = 0.008).
Minimal prospective evidence supports or refutes the use of the functional musculoskeletal exam portion of the current PPE to assess lower extremity injury risk in high school athletes. Limited evidence does support inclusion of multidirectional balance assessment and physical maturation status in a musculoskeletal exam as both are generalizable risk factors for lower extremity injury.
参与运动前身体评估（PPE）的一个既定目标是减少肌肉骨骼损伤，然而据报道，PPE的肌肉骨骼部分在评估高中年龄运动员的下肢损伤风险方面用途存疑。本研究的目的是：（1）确定在前瞻性研究中被证明能有效确定下肢损伤风险的临床评估工具，以及（2）严格评估使用这些工具的前瞻性下肢风险评估研究的方法学质量。
在PubMed、CINAHL、UptoDate、谷歌学术、Cochrane综述和SportDiscus中进行了系统检索。纳入标准为涉及主要年龄在13至19岁运动员的前瞻性损伤风险评估研究，这些研究使用的筛查方法不需要高度专业化的设备。使用改良的物理治疗证据数据库（PEDro）量表评估方法学质量。
纳入了9项研究。改良PEDro评分的平均值为6.0/10（标准差，1.5）。多向平衡（优势比[OR]，3.0；可信区间，1.5 - 6.1；P < 0.05）和身体成熟状态（P < 0.05）可预测总体损伤风险，膝关节过度伸展可预测前交叉韧带损伤（OR，5.0；可信区间，1.2 - 18.4；P < 0.05），髌股疼痛综合征的髋外展：内旋肌力比值（P = 0.02），以及踝关节扭伤的足姿势指数（r = -0.339，P = 0.008）。
极少有前瞻性证据支持或反驳使用当前PPE的功能性肌肉骨骼检查部分来评估高中运动员的下肢损伤风险。有限的证据确实支持在肌肉骨骼检查中纳入多向平衡评估和身体成熟状态，因为两者都是下肢损伤的可推广风险因素。
