School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Sports Med. 2019 Jun;49(6):917-929. doi: 10.1007/s40279-019-01093-x.
BACKGROUND: Anterior cruciate ligament (ACL) return-to-sport (RTS) test batteries are popular and are employed to test athletes' sport performance and help ensure a safe return to sport. OBJECTIVE: To perform a systematic review and meta-analysis to determine: (1) the proportion of patients who passed RTS test batteries after ACL reconstruction, (2) whether passing RTS test batteries increased rates of return to play, and (3) whether passing RTS test batteries reduced subsequent rates of knee and ACL injury. METHODS: Five databases (PubMed, MEDLINE, Embase, CINAHL, and SPORTDiscus) were searched to identify relevant studies and data were extracted regarding the number of patients who passed the RTS test battery, as well as subsequent RTS rates and re-injury data when available. Results were combined using proportional and risk-ratio meta-analyses. RESULTS: Eighteen studies met eligibility criteria. Proportional meta-analysis showed that only 23% of patients passed RTS test batteries. One study showed that passing an RTS test battery led to greater RTS rates. Two studies showed passing RTS test batteries did not significantly reduce the risk of a further knee injury (risk ratio (RR) = 0.28 (95% CI 0.04-0.94), p = 0.09) and five studies showed that passing RTS test batteries did not reduce the risk for all subsequent ACL injuries (RR = 0.80 (95% CI 0.27-2.3), p = 0.7). However, passing an RTS test battery did significantly reduce the risk for subsequent graft rupture (RR = 0.40 (95% CI 0.23-0.69), p < 0.001], although it increased the risk for a subsequent contralateral ACL injury (RR = 3.35 (95% CI 1.52-7.37), p = 0.003]. CONCLUSION: These analyses shows that there are equivocal findings in terms of the validity of current RTS test batteries in relation to reduction of the risk of graft rupture and contralateral ACL injuries. These findings have implications for RTS advice given to patients based on the results of RTS test batteries, and further work is needed to validate the criteria currently used and determine the true value.
背景：前交叉韧带（ACL）重返运动（RTS）测试电池很受欢迎，用于测试运动员的运动表现，并帮助确保安全重返运动。 目的：进行系统评价和荟萃分析，以确定：（1）ACL 重建后通过 RTS 测试电池的患者比例，（2）通过 RTS 测试电池是否会增加重返比赛的比率，以及（3）通过 RTS 测试电池是否会降低随后的膝关节和 ACL 损伤的比率。 方法：五个数据库（PubMed、MEDLINE、Embase、CINAHL 和 SPORTDiscus）被搜索以确定相关研究，并提取有关通过 RTS 测试电池的患者数量以及随后的 RTS 率和再损伤数据的信息。结果使用比例和风险比荟萃分析进行组合。 结果：18 项研究符合入选标准。比例荟萃分析显示，只有 23%的患者通过了 RTS 测试电池。一项研究表明，通过 RTS 测试电池会导致更高的 RTS 率。两项研究表明，通过 RTS 测试电池并不能显著降低进一步膝关节损伤的风险（风险比（RR）=0.28（95%置信区间 0.04-0.94），p=0.09），五项研究表明，通过 RTS 测试电池并不能降低所有随后的 ACL 损伤的风险（RR=0.80（95%置信区间 0.27-2.3），p=0.7）。然而，通过 RTS 测试电池确实显著降低了随后的移植物破裂的风险（RR=0.40（95%置信区间 0.23-0.69），p<0.001]，尽管它增加了随后对侧 ACL 损伤的风险（RR=3.35（95%置信区间 1.52-7.37），p=0.003）。 结论：这些分析表明，目前的 RTS 测试电池在降低移植物破裂和对侧 ACL 损伤的风险方面存在不确定的结果。这些发现对基于 RTS 测试电池结果为患者提供 RTS 建议产生了影响，需要进一步的工作来验证当前使用的标准并确定其真正的价值。
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