School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
Hewett Consulting, Minneapolis and Rochester, Minnesota, U.S.A.
Arthroscopy. 2020 Jun;36(6):1500-1501. doi: 10.1016/j.arthro.2020.03.025. Epub 2020 Apr 4.
Is there value and validity for the use of return-to-sport (RTS) test batteries? With regard to RTS testing, there has been marked interest and rapid growth in studies that document RTS criteria after anterior cruciate ligament reconstruction. A set of criteria or "test-battery" is typically used to "clear" the athlete for RTS. Although most RTS testing is done with aim of assessing safety, the same measurements can be as used to determine the amount of functional capacity regained. It is suggested that RTS test batteries incorporate multiple domains of risk factors. If testing "works," patients who pass should have a lower risk of reinjury than patients who fail but nonetheless return to sport. More recent studies have attempted to cover a broad range of risk factors, with as many as 15 to 20 RTS tests. This is possibly due to a lack of clear evidence as to what are the most important risk factors for second injury. As a result, few patients pass these combined criteria. Findings from a meta-analysis showed that there is a low rate of passing RTS testing (23%). The findings from this and a second meta-analyses are quite similar, as both showed there was no effect of passing RTS test batteries on overall subsequent anterior cruciate ligament injury. There was a 7% to 9% reduction in risk difference of graft injuries with passing of RTS; however, there was a 4% to 9% risk difference or 176% to 235% increased risk of a contralateral injury with passing of RTS criteria. There remain several problems with RTS test batteries, which include low rates of meeting thresholds, many athletes return without meeting RTS thresholds, evidence for predictive value is limited, small sample sizes in many studies (only 2 studies >100 patients), and many studies don't document RTS rates. Additional issues include questions as to whether testing should be staged, how to monitor progression of rehabilitation, and should these RTS batteries be tailored to age groups?
使用重返运动（RTS）测试组合是否具有价值和有效性？关于 RTS 测试，有大量研究记录了前交叉韧带重建后的 RTS 标准，这引起了人们的极大兴趣并促使其快速发展。通常使用一套标准或“测试组合”来“清除”运动员重返运动的障碍。尽管大多数 RTS 测试都是为了评估安全性，但相同的测量值也可用于确定恢复的功能能力量。有人建议 RTS 测试组合应纳入多个风险因素领域。如果测试“有效”，通过测试的患者再次受伤的风险应低于未通过测试但仍重返运动的患者。最近的研究试图涵盖广泛的风险因素，多达 15 到 20 个 RTS 测试。这可能是由于缺乏明确的证据表明哪些是再次受伤的最重要风险因素。因此，很少有患者通过这些综合标准。一项荟萃分析的结果表明，通过 RTS 测试的比例较低（23%）。这一分析和第二项荟萃分析的结果非常相似，因为两者都表明通过 RTS 测试组合对总体后续前交叉韧带损伤没有影响。通过 RTS 测试的患者，其移植物损伤的风险差异降低了 7%至 9%；但是，通过 RTS 标准的患者，其对侧损伤的风险差异增加了 4%至 9%，风险比为 176%至 235%。RTS 测试组合仍然存在几个问题，包括达到阈值的比例较低、许多运动员在未达到 RTS 阈值的情况下返回、预测价值的证据有限、许多研究的样本量较小（只有 2 项研究超过 100 名患者），并且许多研究没有记录 RTS 率。其他问题包括测试是否应分阶段进行、如何监测康复进展以及这些 RTS 测试组合是否应针对年龄组进行定制等问题。
