Grindem Hege, Wellsandt Elizabeth, Failla Mathew, Snyder-Mackler Lynn, Risberg May Arna
Norwegian Research Center for Active Rehabilitation, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.
Orthop J Sports Med. 2018 May 23;6(5):2325967118774255. doi: 10.1177/2325967118774255. eCollection 2018 May.
More than 50% of highly active patients with an anterior cruciate ligament (ACL) injury who choose nonsurgical treatment (active rehabilitation alone) have successful 2-year outcomes and comparable knee function to an uninjured population. Early predictive factors for a successful outcome may aid treatment decision making in this population.
To identify early predictors of a successful 2-year outcome in those who choose nonsurgical treatment of an ACL injury.
Cohort study; Level of evidence, 2.
This prospective cohort study consisted of ACL-injured athletes who were consecutively screened for inclusion. A total of 300 patients were included from 2 sites (Oslo, Norway, and Delaware, USA), and the 118 patients who initially chose not to undergo ACL reconstruction were included. All patients participated in pivoting sports before the injury, and none had significant concomitant injuries. A successful 2-year outcome was defined as having 2-year International Knee Documentation Committee (IKDC) scores ≥15th normative percentile and not undergoing ACL reconstruction. Multivariable logistic regression models were built using demographic and knee function data (quadriceps muscle strength, 4 single-leg hop tests, IKDC score, and Knee Outcome Survey-Activities of Daily Living Scale [KOS-ADLS] score) collected at baseline or after a 5-week neuromuscular and strength training (NMST) rehabilitation program.
After 2 years, 52 of 97 (53.6%) patients had a successful outcome. In the multivariable baseline model, older age, female sex, better performance on the single-leg hop test, and a higher KOS-ADLS score were significantly associated with successful 2-year outcomes. After the 5-week NMST rehabilitation program, older age, female sex, and a higher IKDC score increased the odds of a successful 2-year outcome. The 2 models had comparable predictive accuracy (post-NMST area under the curve [AUC], 0.78 [95% CI, 0.68-0.88]; baseline AUC, 0.81 [95% CI, 0.72-0.89]).
Clinicians and patients can be more confident in a nonsurgical treatment choice (active rehabilitation alone) in athletes who are female, are older in age, and have good knee function, as measured by single-leg hop tests and patient-reported outcome measures, early after an ACL injury. Prediction models that include measures of knee function, assessed either before or after rehabilitation, can estimate 2-year prognoses for nonsurgical treatment and thereby assist shared treatment decision making.
超过50%选择非手术治疗（仅积极康复）的前交叉韧带（ACL）损伤高活动度患者有成功的2年预后，且膝关节功能与未受伤人群相当。成功预后的早期预测因素可能有助于该人群的治疗决策。
确定选择ACL损伤非手术治疗患者2年成功预后的早期预测因素。
队列研究；证据等级，2级。
这项前瞻性队列研究纳入了连续筛查符合纳入标准的ACL损伤运动员。来自2个地点（挪威奥斯陆和美国特拉华州）的300例患者被纳入研究，其中118例最初选择不进行ACL重建的患者被纳入。所有患者在受伤前都从事旋转运动，且均无严重合并伤。2年成功预后定义为2年国际膝关节文献委员会（IKDC）评分≥第15百分位正常值且未进行ACL重建。使用基线时或经过5周神经肌肉和力量训练（NMST）康复计划后收集的人口统计学和膝关节功能数据（股四头肌力量、4项单腿跳测试、IKDC评分和膝关节结果调查 - 日常生活活动量表 [KOS-ADLS] 评分）建立多变量逻辑回归模型。
2年后，97例患者中有52例（53.6%）预后成功。在多变量基线模型中，年龄较大、女性、单腿跳测试表现较好以及KOS-ADLS评分较高与2年成功预后显著相关。经过5周的NMST康复计划后，年龄较大、女性以及IKDC评分较高增加了2年成功预后的几率。这两个模型具有相当的预测准确性（NMST后曲线下面积 [AUC]，0.78 [95% CI，0.68 - 0.88]；基线AUC，0.81 [95% CI，0.72 - 0.89]）。
对于ACL损伤后早期女性、年龄较大且膝关节功能良好（通过单腿跳测试和患者报告的结局指标衡量）的运动员，临床医生和患者对于非手术治疗选择（仅积极康复）可以更有信心。包含康复前后评估的膝关节功能指标的预测模型可以估计非手术治疗的2年预后，从而协助共同做出治疗决策。
