University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada.
Am J Sports Med. 2018 Nov;46(13):3307-3316. doi: 10.1177/0363546517732541. Epub 2017 Oct 13.
Physicians counseling athletes on the prognosis of sport-specific performance outcomes after anterior cruciate ligament reconstruction (ACLR) depend on the published literature. However, critical appraisal of the validity and biases in these studies is required to understand how ACLR affects an athlete's ability to return to sport, the athlete's sport-specific performance, and his or her ability to achieve preinjury levels of performance.
This review identifies the published prognostic studies evaluating sport-specific performance outcomes after ACLR. A risk of bias assessment and summaries of return to sport and career longevity results are provided for each included study.
Systematic review.
Electronic databases (Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PUBMED) were searched via a defined search strategy with no limits, to identify relevant studies for inclusion in the review. A priori defined eligibility criteria included studies measuring sport-specific performance within an athlete's sport, before and after primary ACLR. Reference lists of eligible studies were hand-searched for additional relevant studies. Data extraction was performed by use of a standardized spreadsheet. Each included study was assessed by use of 6 bias domains of the Quality in Prognosis Studies tool to critically appraise study participation, study attrition, prognostic factors, outcome measurement, confounders, and statistical analysis and reporting. Two authors independently performed each stage of the review and reached consensus through discussion.
Fifteen pertinent prognostic studies evaluated sport-specific performance outcomes and/or return to play after ACLR for athletes participating in competitive soccer, football, ice hockey, basketball, Alpine ski, X-Games ski and snowboarding, and baseball. Twelve of these studies were considered to have a high level of bias.
This review demonstrated that most high-performance or professional athletes returned to their preinjury level of sport after ACLR. The bulk of evidence suggests there was a measurable decrease in performance statistics, although this is highly sport-specific. A paucity of literature is available that addresses sport-specific performance in athletes after ACLR. This review has determined that the available literature is highly biased and must be read with caution.
By better understanding the validity and biases in the published literature, physicians can provide more informed prognoses about return to sport-specific performance after ACLR while considering risk factors relevant to their patients.
CRD42016046709 (International Prospective Register of Systematic Reviews, https://www.crd.york.ac.uk/prospero/ ).
在为前交叉韧带重建（ACLR）后的运动员提供运动特异性表现预后的咨询时，医生依赖于已发表的文献。然而，为了了解 ACLR 如何影响运动员重返运动的能力、运动员的运动特异性表现以及他或她恢复到受伤前的表现水平，需要对这些研究的有效性和偏差进行批判性评估。
本综述确定了已发表的评估 ACLR 后运动特异性表现结果的预后研究。对每个纳入研究的风险偏倚评估和重返运动及职业寿命结果进行了总结。
系统综述。
通过无限制的定义搜索策略，在电子数据库（Ovid MEDLINE、EMBASE、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库和 PUBMED）中搜索相关研究，以纳入本综述。预先定义的纳入标准包括在运动员的运动项目中测量运动特异性表现的研究，且研究必须在初次 ACLR 之前和之后进行。对合格研究的参考文献列表进行了手工检索，以寻找其他相关研究。使用标准化电子表格进行数据提取。使用预后研究质量工具的 6 个偏倚域对每个纳入的研究进行评估，以批判性地评估研究参与、研究脱落、预后因素、结果测量、混杂因素以及统计分析和报告。两位作者独立进行了综述的每个阶段，并通过讨论达成共识。
有 15 项相关的预后研究评估了 ACLR 后运动员参加职业足球、橄榄球、冰球、篮球、高山滑雪、X 游戏滑雪和单板滑雪以及棒球运动的运动特异性表现结果和/或重返运动的情况。其中 12 项研究被认为存在较高的偏倚。
本综述表明，大多数高水平或职业运动员在 ACLR 后都能恢复到受伤前的运动水平。大多数证据表明，运动表现数据存在可衡量的下降，尽管这在很大程度上取决于运动类型。可用文献中很少有关于 ACLR 后运动员运动特异性表现的内容。本综述确定，现有文献存在高度偏差，在阅读时必须谨慎。
通过更好地理解已发表文献的有效性和偏差，医生可以在考虑与患者相关的风险因素的情况下，提供关于 ACLR 后重返运动特异性表现的更有依据的预后。
CRD42016046709（国际前瞻性系统评价注册库，https://www.crd.york.ac.uk/prospero/ ）。
