Sports Health. 2018 May/Jun;10(3):266-271. doi: 10.1177/1941738118759911. Epub 2018 Feb 27.
BACKGROUND: There is a lack of literature-based objective criteria for return to sport after anterior cruciate ligament (ACL) injury. Establishing such objective criteria is crucial to improving return to sport after ACL reconstruction (ACLR). HYPOTHESES: Patients who return to their preinjury level of sport will have higher isokinetic, postural stability, and drop vertical jump test scores 6 months after surgery and greater patient satisfaction compared with those who did not. Additionally, quadriceps strength deficit cutoff values of 80% and 90% would differentiate patients who returned to preinjury sports level from those who did not. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A retrospective search was conducted to identify all patients who underwent ACLR and completed isokinetic evaluation, postural stability analysis, and drop vertical jump testing at 6 months postoperatively. Patients were asked to complete 3 questionnaires at a minimum 1 year after surgery. Chi-square and logistic regression analyses were used for categorical dependent variables, while the Student t test, Pearson correlation, or analyses of variance with Bonferroni post hoc testing were used for continuous dependent variables. A post hoc power analysis was completed. Based on the results regarding correlations between return to preinjury level and all other variables, effect sizes from 0.24 to 3.03 were calculated. With these effect sizes, an alpha of 0.05 and sample size of 58, a power ranging from 0.15 to 0.94 was calculated. RESULTS: The rates of return to preinjury level and to any sports activity were 53.4% and 84.4%. Those who were able to return to their preinjury level of sport (n = 33) showed significantly higher Lysholm (91.6 ± 9.7 vs 76.7 ± 15.4) and International Knee Documentation Committee (IKDC) (83.6 ± 10.6 vs 69.8 ± 14.6) values compared with those who were unable to return to their preinjury level of sport (n = 25) ( P < 0.001). No significant differences were found for the clinical evaluations between those who were and those who were not able to return at the same level for the clinical evaluations (isokinetic evaluation, postural stability, drop vertical jump test) ( P > 0.05). No significant differences were found when comparing quadriceps strength deficit with cutoff values of 80% and 90% for return to preinjury activity level (Tegner), Lysholm, and IKDC scores. CONCLUSION: Quadriceps strength deficit, regardless of cutoff value (80% or 90%), at 6 months after ACLR does not predict return to preinjury level of sport. Patients who returned to sport at their preinjury level were more satisfied with their reconstruction compared with those who did not. CLINICAL RELEVANCE: Quadriceps strength deficit is not a reliable predictor of return to sports, and therefore it should not be used as the single criterion in such evaluations.
背景:在 ACL 损伤后,缺乏基于文献的客观标准来恢复运动。建立这样的客观标准对于改善 ACLR 后的运动恢复至关重要。
假设:重返运动前水平的患者在术后 6 个月的等速、姿势稳定性和垂直跳跃测试评分以及患者满意度方面将高于未重返运动前水平的患者。此外,股四头肌力量缺陷 80%和 90%的截断值将区分返回运动前水平的患者和未返回的患者。
研究设计:队列研究。
证据水平:3 级。
方法:进行了回顾性搜索,以确定所有接受 ACLR 并在术后 6 个月完成等速评估、姿势稳定性分析和垂直跳跃测试的患者。患者在手术后至少 1 年完成了 3 份问卷。使用卡方检验和逻辑回归分析分类因变量,而使用学生 t 检验、皮尔逊相关或方差分析与 Bonferroni 事后检验分析连续因变量。完成了事后功效分析。基于与返回运动前水平相关的所有其他变量之间的相关性,计算出效应大小为 0.24 至 3.03。根据这些效应大小,在 α 值为 0.05 和样本量为 58 的情况下,计算出的功效范围为 0.15 至 0.94。
结果:返回运动前水平和任何运动活动的比例分别为 53.4%和 84.4%。那些能够恢复到运动前水平的患者(n=33)的 Lysholm(91.6±9.7 比 76.7±15.4)和国际膝关节文献委员会(IKDC)(83.6±10.6 比 69.8±14.6)评分明显高于那些无法恢复到运动前水平的患者(n=25)(P<0.001)。在能够和不能恢复到相同运动水平的患者之间,临床评估的临床评估(等速评估、姿势稳定性、垂直跳跃测试)没有显著差异(P>0.05)。对于股四头肌力量缺陷与 80%和 90%的截断值用于预测重返运动前活动水平(Tegner)、Lysholm 和 IKDC 评分,没有发现显著差异。
结论:ACL 重建后 6 个月股四头肌力量缺陷,无论截断值(80%或 90%)如何,都不能预测运动前的运动恢复水平。与未返回运动的患者相比,重返运动的患者对重建的满意度更高。
临床相关性:股四头肌力量缺陷不是恢复运动的可靠预测指标,因此不应将其作为此类评估的唯一标准。
J Orthop Sports Phys Ther. 2019-2-15
J Orthop Sports Phys Ther. 2017-5
Knee Surg Sports Traumatol Arthrosc. 2017-9-16
Am J Sports Med. 2018-12-7
Orthop Traumatol Surg Res. 2017-11
Int J Sports Phys Ther. 2024-9-2
Curr Rev Musculoskelet Med. 2017-9
J Bone Joint Surg Am. 2017-5-3
Knee Surg Sports Traumatol Arthrosc. 2016-1
Orthopedics. 2014-2