Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio.
Division of Sports Physical Therapy, Children's Hospital of Colorado, Aurora, Colorado.
Sports Health. 2018 May/Jun;10(3):228-233. doi: 10.1177/1941738117745806. Epub 2017 Dec 22.
BACKGROUND: Outcomes after anterior cruciate ligament reconstruction (ACLR) are highly variable. Previous studies have failed to report the relationship between fear, objective measures of function, and reinjury rates. The purpose of this study was to determine whether fear was related to functional performance measures and risk of second ACL injury after ACLR and return to sport (RTS). HYPOTHESIS: Fear will be associated with performance on functional testing and second ACL injury rate. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 40 patients cleared to RTS after ACLR completed the Tampa Scale of Kinesiophobia (TSK-11), hop testing, and quadriceps strength testing, bilaterally. Patients were tracked for 12 months after RTS to identify the incidence of second ACL injury. Chi-square analyses determined whether patients with high fear (TSK-11, ≥17) were more likely to have lower levels of activity, greater asymmetry on functional testing, and higher reinjury rates. RESULTS: Patients with greater fear on the TSK-11 (≥17) at RTS were 4 times (odds ratio [OR], 3.73; 95% CI, 0.98-14.23) more likely to report lower levels of activity, 7 times (OR, 7.1; 95% CI, 1.5-33.0) more likely to have a hop limb symmetry lower than 95%, and 6 times (OR, 6.0; 95% CI, 1.3-27.8) more likely to have quadriceps strength symmetry lower than 90%. Patients who went on to suffer an ipsilateral second ACL injury had a greater TSK-11 score at the time of RTS (mean, 19.8 ± 4.0) than those who did not suffer a second ACL injury (mean, 16.4 ± 3.6) ( P = 0.03). Patients with a TSK-11 score of 19 or greater at the time of RTS were 13 times (relative risk, 13.0; 95% CI, 2.1-81.0) more likely to suffer a second ACL tear within 24 months after RTS. CONCLUSION: Patients with greater self-reported fear were less active, presented with lower single-leg hop performance and isometric quadriceps strength, and had an increased risk of suffering a second ACL injury in the 24 months after RTS. CLINICAL RELEVANCE: Self-reported fear of movement/reinjury after ACLR at the time of RTS may be an important measure to incorporate into discharge criteria prior to release to return to pivoting and cutting sports after ACLR.
背景：前交叉韧带重建（ACLR）后的结果差异很大。先前的研究未能报告恐惧、功能的客观测量与再损伤率之间的关系。本研究的目的是确定恐惧是否与 ACLR 后功能表现测量和二次 ACL 损伤以及重返运动（RTS）的风险有关。 假设：恐惧将与功能测试表现和 ACL 二次损伤率相关。 研究设计：前瞻性队列研究。 证据水平：2 级。 方法：ACL 重建后达到 RTS 标准的 40 名患者完成了 Tampa 运动恐惧量表（TSK-11）、跳跃测试和双侧股四头肌力量测试。在 RTS 后 12 个月内对患者进行跟踪，以确定二次 ACL 损伤的发生率。卡方分析确定高恐惧（TSK-11，≥17）的患者是否更有可能活动水平较低、功能测试的不对称程度更大，以及再损伤率更高。 结果：在 RTS 时 TSK-11（≥17）得分较高的患者报告活动水平较低的可能性是对照组的 4 倍（比值比[OR]，3.73；95%置信区间[CI]，0.98-14.23），跳跃测试的腿对称性低于 95%的可能性是对照组的 7 倍（OR，7.1；95%CI，1.5-33.0），股四头肌力量对称性低于 90%的可能性是对照组的 6 倍（OR，6.0；95%CI，1.3-27.8）。同侧二次 ACL 损伤的患者在 RTS 时的 TSK-11 评分更高（平均，19.8±4.0），而非二次 ACL 损伤的患者（平均，16.4±3.6）（P=0.03）。RTS 时 TSK-11 评分达到或超过 19 分的患者在 RTS 后 24 个月内遭受二次 ACL 撕裂的风险是对照组的 13 倍（相对风险[RR]，13.0；95%CI，2.1-81.0）。 结论：自我报告恐惧程度较高的患者活动量较少，单腿跳跃测试和等长股四头肌力量表现较差，且在 ACLR 后 24 个月内遭受二次 ACL 损伤的风险增加。 临床相关性：ACL 重建后 RTS 时对运动/损伤的自我报告恐惧可能是 ACLR 后重返旋转和切割运动前纳入出院标准的重要指标。
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