Vopat Matthew L, Hassan Maaz, Poppe Tanner, Tarakemeh Armin, Zackula Rosey, Mulcahey Mary K, Mullen Scott, Burkholder Rick, Schroeppel John Paul, Vopat Bryan G
University of Kansas School of Medicine, Wichita, Kansas, USA.
University of Kansas Medical Center, Kansas City, Kansas, USA.
Orthop J Sports Med. 2019 Oct 14;7(10):2325967119875133. doi: 10.1177/2325967119875133. eCollection 2019 Oct.
The prevalence of turf toe injuries has increased in recent years. However, uncertainty remains as to how to optimally treat turf toe injuries and the implications that the severity of the injury has on outcomes, specifically return to sport (RTS).
To determine RTS based on treatment modality and to provide clinicians with additional information when comparing operative versus nonoperative treatment of turf toe injuries in athletes.
Systematic review; Level of evidence, 4.
A systematic review and meta-analysis was performed using the PubMed/Ovid MEDLINE/PubMed Central databases (May 1964 to August 2018) per PRISMA-IPD (Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data) guidelines. RTS, treatment, severity of injury, athletic position, and sport were recorded and analyzed.
Of 858 identified studies, 12 met the criteria for the final meta-analysis. The studies included 112 athletes sustaining a total of 121 turf toe injuries; 63 (52.1%) of these injuries were treated surgically, while 58 (47.9%) were treated nonoperatively, and 53.7% were classified by the grade of injury (grade I, n = 1; grade II, n = 9; grade III, n = 55). Overall, 56 (46.3%) injuries could not be classified based on the data provided and were excluded from the final analysis. The median time to RTS for patients treated nonoperatively was 5.85 weeks (range, 3.00-8.70 weeks) compared with 14.70 weeks (range, 6.00-156.43 weeks) for patients treated surgically ( < .001); however, there was variability in the grade of injury between the 2 groups. Similarly, patients who sustained grade II injuries returned to sport more quickly (8.70 weeks) than patients who had a grade I (13.04 weeks) or grade III injury (16.50 weeks) ( = .016). The amount of time required to RTS was significantly influenced by the athlete's level of play (16.50 weeks for both high school and college levels; 14.70 weeks for professional level) ( = .018).
The time to RTS for an athlete who suffers from a turf toe injury is significantly influenced by the severity of injury and the athlete's level of competition. Professional athletes who suffer from turf toe injuries RTS sooner than both high school and college athletes. However, there are a limited number of high-level studies evaluating turf toe injuries in the athletic population. Further research is necessary to clearly define the appropriate treatment and RTS protocols based on sport, position, and level of play.
近年来，趾跖关节损伤的患病率有所增加。然而，关于如何最佳治疗趾跖关节损伤以及损伤严重程度对预后（特别是恢复运动）的影响仍存在不确定性。
根据治疗方式确定恢复运动情况，并为临床医生在比较运动员趾跖关节损伤的手术治疗与非手术治疗时提供更多信息。
系统评价；证据等级为4级。
按照PRISMA-IPD（个体参与者数据系统评价和荟萃分析的首选报告项目）指南，使用PubMed/Ovid MEDLINE/PubMed Central数据库（1964年5月至2018年8月）进行系统评价和荟萃分析。记录并分析恢复运动情况、治疗方法、损伤严重程度、运动位置和运动项目。
在858项已识别的研究中，12项符合最终荟萃分析的标准。这些研究包括112名运动员，共发生121例趾跖关节损伤；其中63例（52.1%）损伤接受了手术治疗，58例（47.9%）接受了非手术治疗，53.7%的损伤根据损伤等级进行了分类（I级，n = 1；II级，n = 9；III级，n = 55）。总体而言，56例（46.3%）损伤无法根据所提供的数据进行分类，被排除在最终分析之外。非手术治疗患者恢复运动的中位时间为5.85周（范围3.00 - 8.70周），而手术治疗患者为14.70周（范围6.00 - 156.43周）（P <.001）；然而，两组之间的损伤等级存在差异。同样，II级损伤患者比I级损伤（13.04周）或III级损伤（16.50周）患者恢复运动更快（8.70周）（P =.016）。恢复运动所需的时间受运动员比赛水平的显著影响（高中和大学水平均为16.50周；职业水平为14.70周）（P =.018）。
趾跖关节损伤运动员的恢复运动时间受损伤严重程度和运动员比赛水平的显著影响。患有趾跖关节损伤的职业运动员比高中和大学运动员恢复运动更快。然而，评估运动员群体中趾跖关节损伤的高水平研究数量有限。有必要进行进一步研究，以根据运动项目、位置和比赛水平明确界定合适的治疗方法和恢复运动方案。
