女性运动员前交叉韧带断裂的预防：一项系统评价

Prevention of Anterior Cruciate Ligament Rupture in Female Athletes: A Systematic Review.

作者信息

Ramirez Rey N, Baldwin Keith, Franklin Corinna C D

机构信息

Shriners Hospitals for Children, 3551 North Broad Street, Philadelphia, PA 19140.

Children's Hospital of Philadelphia, 34th Street and Civic Boulevard, Philadelphia, PA 19140.

出版信息

JBJS Rev. 2014 Sep 16;2(9). doi: 10.2106/JBJS.RVW.M.00129.

DOI:10.2106/JBJS.RVW.M.00129

PMID:27490154

Abstract

BACKGROUND

A number of reports have been published on the effectiveness and design of intervention programs for the prevention of rupture of the anterior cruciate ligament (ACL) in female athletes. The purpose of this study was to systematically review the literature to determine the effectiveness of neuromuscular training programs in preventing ACL injury in female athletes.

METHODS

A systematic review was performed with use of the PubMed, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases. The search terms included "anterior cruciate ligament" and "ACL" combined with "prevention" and "intervention." The searches included material indexed by September 30, 2013. Data concerning study design, the characteristics of participants, the details of the neuromuscular programs, the types of sports, and number of ACL ruptures were extracted from the studies. Study heterogeneity was assessed with funnel plot and Egger regression methods. Pooled effects were calculated with use of a DerSimonian-Laird random-effects model. The number needed to treat was calculated on the basis of pooled incidence data.

RESULTS

The risk of ACL rupture was 1.83 times higher for female athletes who did not participate in neuromuscular ACL-prevention training programs (odds ratio [OR], 1.83; 95% confidence interval [95% CI], 1.08 to 3.10; p = 0.02). In studies that focused exclusively on soccer, the risk of ACL rupture was 2.62 times higher for nonparticipating athletes (OR, 2.62; 95% CI, 1.59 to 4.32; p < 0.01). When the data were analyzed according to the timing of the intervention, no significant effects were found. In studies in which the program took place both preseason and in-season, the risk (odds ratio) of ACL rupture for nonparticipating athletes was 2.34 (95% CI, 0.82 to 6.7; p = 0.11). In studies in which the intervention took place in-season only, the risk (odds ratio) of ACL rupture for nonparticipating athletes was 1.25 (95% CI, 0.23 to 6.75; p = 0.8). The number needed to treat to prevent a single ACL rupture was 128.7 athletes. We found no significant heterogeneity among the included studies. The I value was 35.40% (p = 0.11). No significant publication bias was found in our included studies.

CONCLUSIONS

The results of this systematic review and meta-analysis favor a protective effect of neuromuscular training programs on the risk of ACL rupture in female athletes. This protective effect is more pronounced in soccer players. Additional research is needed to design the optimal training program.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

摘要

背景

关于女性运动员前交叉韧带（ACL）损伤预防干预项目的有效性和设计，已有多篇报道发表。本研究的目的是系统回顾文献，以确定神经肌肉训练项目在预防女性运动员ACL损伤方面的有效性。

方法

使用PubMed、MEDLINE、Embase和Cochrane对照试验中央注册库数据库进行系统回顾。检索词包括“前交叉韧带”和“ACL”，并与“预防”和“干预”相结合。检索涵盖截至2013年9月30日索引的资料。从研究中提取有关研究设计、参与者特征、神经肌肉项目细节、运动类型和ACL断裂数量的数据。采用漏斗图和Egger回归方法评估研究异质性。使用DerSimonian-Laird随机效应模型计算合并效应。根据合并发病率数据计算需治疗人数。

结果

未参加神经肌肉ACL预防训练项目的女性运动员ACL断裂风险高1.83倍（优势比[OR]，1.83；95%置信区间[95%CI]，1.08至3.10；p = 0.02）。在仅关注足球的研究中，未参加训练的运动员ACL断裂风险高2.62倍（OR，2.62；95%CI，1.59至4.32；p < 0.01）。根据干预时间分析数据时，未发现显著影响。在季前赛和赛季中均开展项目的研究中，未参加训练的运动员ACL断裂风险（优势比）为2.34（95%CI，0.82至6.7；p = 0.11）。在仅在赛季中进行干预的研究中，未参加训练的运动员ACL断裂风险（优势比）为1.25（95%CI，0.23至6.75；p = 0.8）。预防一例ACL断裂所需治疗人数为128.7名运动员。我们发现纳入研究之间无显著异质性。I值为35.40%（p = 0.11）。在我们纳入的研究中未发现显著的发表偏倚。