Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Department of Orthopedic Surgery and Sports Medicine, Hospital for Special Surgery, 535 E 70th St, New York, NY, USA.
Knee Surg Sports Traumatol Arthrosc. 2018 Apr;26(4):1019-1036. doi: 10.1007/s00167-018-4830-9. Epub 2018 Jan 13.
To evaluate the rate at which children and adolescent athletes return to sporting activities after anterior cruciate ligament (ACL) reconstruction.
Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until September 9, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes. Book chapters, conference papers, review articles, and technical reports were excluded. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model.
Overall, 20 studies with a combined total of 1156 ACL reconstructions met the inclusion criteria, with a mean age of 14.3 years (range 6-19) and a mean follow-up time of 6.5 years (range 1-22). All studies were level IV evidence (14 retrospective case series and 6 prospective case series). The pooled rate of return to any sport participation was 92.0% [95% confidence interval (CI), 86-96%]. The pooled rate of return to pre-injury level of sport was 78.6% (95% CI 71-86%) and that to competitive level of sport was 81.0% (95% CI 62-94%). A total of 93 of the 717 assessed athletes (13%) sustained re-injuries with graft ruptures, and in 91 of 652 patients (14%), contralateral ACL injuries were reported on final follow-up.
Pooled results suggest a high rate of return to sport following ACL reconstruction in children and adolescent athletes; however, this is associated with a relatively high rate of graft rupture and a similar rate of contralateral ACL injury. This study provides clinicians with evidence-based data on the ability of children and adolescent athletes to return to sport after ACL reconstruction, an important consideration for athletes of this population with ACL injuries.
IV, systematic review of level IV studies.
评估儿童和青少年运动员在前交叉韧带（ACL）重建后重返运动的比例。
两位评审员独立地、重复地在 3 个数据库（PubMed、MEDLINE 和 EMBASE）中进行了检索，检索时间从数据库建立开始到 2017 年 9 月 9 日。纳入标准为报告运动回归结果的英语研究。排除章节书籍、会议论文、综述文章和技术报告。使用随机效应模型对比例进行荟萃分析来合并运动回归率。
总体而言，有 20 项研究共纳入 1156 例 ACL 重建，符合纳入标准，平均年龄为 14.3 岁（6-19 岁），平均随访时间为 6.5 年（1-22 年）。所有研究均为 IV 级证据（14 项回顾性病例系列研究和 6 项前瞻性病例系列研究）。所有运动项目参与的总体回归率为 92.0%（95%置信区间：86-96%）。重返受伤前运动水平的回归率为 78.6%（95%置信区间：71-86%），重返竞技运动水平的回归率为 81.0%（95%置信区间：62-94%）。在 717 名评估运动员中，有 93 名（13%）发生了再损伤，包括移植物破裂，在 652 名患者中，有 91 名（14%）在最终随访时报告了对侧 ACL 损伤。
汇总结果表明，儿童和青少年运动员前交叉韧带重建后重返运动的比例较高；但这与较高的移植物破裂率和相似的对侧 ACL 损伤率有关。本研究为儿童和青少年运动员前交叉韧带重建后重返运动的能力提供了基于循证的证据，这是 ACL 损伤运动员的重要考虑因素。
IV，IV 级研究的系统评价。
