Graziano Jessica, Chiaia Theresa, de Mille Polly, Nawabi Danyal H, Green Daniel W, Cordasco Frank A
ADI Rehab Inc, Los Angeles, California, USA.
Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2017 Apr 20;5(4):2325967117700599. doi: 10.1177/2325967117700599. eCollection 2017 Apr.
Reinjury rates after anterior cruciate ligament reconstruction (ACLR) are highest among young athletes, who consequently suffer from low rates of return to play. Historically, quantitative measures have been used to determine readiness to return to sport; however, they do not assess modifiable risk factors related to the quality of movement.
To determine the effectiveness of a criteria-based rehabilitation progression and return-to-sport criteria on efficient return to activity and prevention of second injury in young athletes post-ACLR.
Case series; Level of evidence, 4.
Between December 2010 and 2013, 42 skeletally immature athletes (mean chronologic age, 12 years; range, 10-15 years) who underwent ACLR using ipsilateral hamstring tendon autograft were prospectively evaluated. All athletes progressed through a criteria-based rehabilitation progression; were assessed at specific time frames for strength, biomechanical, and neuromuscular risk factors predictive of injury; and were provided targeted interventions. The final return to sport phase consisted of quantitative testing as well as a quality of movement assessment of several functional movements with progressive difficulty and sports-specific loading. Clearance for unrestricted activity was determined by achieving satisfactory results on both qualitative and quantitative assessments with consideration for the demands of each sport.
The mean time for return to unrestricted competitive activity was 12 months. All but 3 (7%) athletes returned to their primary sport. Thirty-five athletes (83%) returned to unrestricted activity. Of the 6 (14%) who sustained a second injury, 3 (50%) were injured in sports they were not cleared for. All ACL reinjuries occurred in a cutting sport. Half of reinjuries occurred within 1 year of surgery, while the remaining occurred between 1 and 2 years. Eighty-three percent of reinjuries involved highly competitive cutting athletes.
In our cohort, the combination of qualitative and quantitative data served as a good indicator for reducing risk and determining readiness to return to sport.
前交叉韧带重建术（ACLR）后再损伤率在年轻运动员中最高，因此他们恢复运动的比例较低。从历史上看，定量测量一直用于确定恢复运动的准备情况；然而，它们并未评估与运动质量相关的可改变风险因素。
确定基于标准的康复进程和恢复运动标准对年轻运动员ACL重建术后有效恢复活动和预防二次损伤的有效性。
病例系列；证据等级，4级。
在2010年12月至2013年期间，对42名骨骼未成熟的运动员（平均实际年龄12岁；范围10 - 15岁）进行了前瞻性评估，这些运动员使用同侧腘绳肌腱自体移植进行了ACLR。所有运动员都按照基于标准的康复进程进行；在特定时间框架内评估预测损伤的力量、生物力学和神经肌肉风险因素；并接受针对性干预。最终的恢复运动阶段包括定量测试以及对几个难度逐渐增加的功能性动作和特定运动负荷的运动质量评估。根据定性和定量评估均取得满意结果并考虑每项运动的要求来确定无限制活动的许可。
恢复无限制竞技活动的平均时间为12个月。除3名（7%）运动员外，所有运动员都恢复了他们的主要运动项目。35名运动员（83%）恢复了无限制活动。在6名（14%）遭受二次损伤的运动员中，3名（50%）在未获许可的运动项目中受伤。所有ACL再损伤均发生在切入类运动中。一半的再损伤发生在手术后1年内，其余发生在1至2年之间。83%的再损伤涉及高竞争性切入类运动员。
在我们的队列中，定性和定量数据的结合是降低风险和确定恢复运动准备情况的良好指标。
