Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada.
University of Saskatchewan, Regina, Saskatchewan, Canada.
Am J Sports Med. 2020 Jun;48(7):1682-1688. doi: 10.1177/0363546520918224. Epub 2020 May 7.
BACKGROUND: For many athletes, a tear of the anterior cruciate ligament (ACL) represents a significant injury that requires a prolonged period away from the sport with substantial rehabilitation. HYPOTHESIS: There will be no difference in return to play (RTP) and career length after hamstring tendon (HT) ACL reconstruction in a group of Canadian Football League professional players as compared with what has been already been reported in the literature among professional football players. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Data on athletes who sustained an ACL injury were collected by team physicians and head athletic trainers from 2002 to 2017 from 2 Canadian Football League teams. Patient details included age at the time of injury, initial injury date, position, practice versus game injury, and primary versus rerupture with injury-specific data, such as affected limb, concomitant injuries, graft choice, and procedure performed. RTP rates and career length data were collected through publically available internet sources. Comparisons between the non-RTP and RTP groups were made with independent-sample tests. Binomial logistic regression was performed to determine variables (ie, games preinjury, graft type, meniscal injury, collateral ligament injury) that contributed to players not being able to RTP. RESULTS: A total of 44 ACL reconstructions were performed over the study period (HT, n = 32 [72.7%]; bone-patellar tendon-bone [BPTB], n = 8 [18.2%]; allograft, n = 4 [9.1%]). Overall, 69.8% (n = 30) were able to RTP in at least 1 game, while 30.2% (n = 13) did not return. Mean time to return was 316.1 days (range, 220-427 days), or 10.4 months. For those players who did RTP, mean career length after ACL reconstruction was 2.8 seasons, or 34.4 games. The majority (56.8%) of injuries occurred early in the season. Breakdown by graft type demonstrated RTP rates among HT, BPTB, and allograft of 64.5% (n = 20), 87.5% (n = 7), and 75% (n = 3), respectively. Career length among HT, BPTB, and allograft was 2.9, 2.4, and 3 seasons. Logistic regression analysis found only concomitant medial collateral ligament (MCL) injuries to be a negative predictor for RTP. Meniscal injuries were associated with a decreased RTP rate and career length, but this was not statistically significant. CONCLUSION: The RTP rates after ACL reconstruction in this study are similar to those reported in National Football League players. A concomitant injury to the MCL injury was a negative predictor of RTP. Meniscal injuries demonstrated a trend for decreased RTP rate and career length, but this was not a significant predictor. A large portion of injuries occur early in the season, and further study should be done to examine potential preventative strategies to reduce ACL injuries.
背景:对于许多运动员来说,前交叉韧带(ACL)撕裂是一种严重的伤害,需要长时间远离运动并进行大量康复。
假设:与文献中已经报道的职业足球运动员相比,在一组加拿大足球联盟职业球员中,跟腱(HT)ACL 重建后重返赛场(RTP)和职业生涯长度不会有差异。
研究设计:病例对照研究;证据水平,3 级。
方法:通过团队医生和首席运动训练师从 2002 年到 2017 年从两支加拿大足球联盟球队收集了遭受 ACL 损伤的运动员的数据。患者详细信息包括受伤时的年龄、初始受伤日期、位置、练习与比赛受伤、初次与再撕裂,以及与损伤特异性相关的数据,例如受累肢体、合并伤、移植物选择和手术方式。通过公开的互联网来源收集 RTP 率和职业生涯长度数据。通过独立样本 t 检验比较非 RTP 和 RTP 组。进行二项逻辑回归以确定不能 RTP 的球员的变量(即,比赛前的比赛、移植物类型、半月板损伤、侧副韧带损伤)。
结果:在研究期间共进行了 44 例 ACL 重建(HT,n = 32 [72.7%];骨-髌腱-骨 [BPTB],n = 8 [18.2%];同种异体移植物,n = 4 [9.1%])。总体而言,69.8%(n = 30)至少能 RTP 一场比赛,而 30.2%(n = 13)无法返回。平均 RTP 时间为 316.1 天(范围,220-427 天),或 10.4 个月。对于那些能够 RTP 的球员,ACL 重建后的平均职业生涯长度为 2.8 个赛季,或 34.4 场比赛。大多数(56.8%)受伤发生在赛季早期。按移植物类型分析,HT、BPTB 和同种异体移植物的 RTP 率分别为 64.5%(n = 20)、87.5%(n = 7)和 75%(n = 3)。HT、BPTB 和同种异体移植物的职业生涯长度分别为 2.9、2.4 和 3 个赛季。逻辑回归分析发现只有合并的内侧副韧带(MCL)损伤是 RTP 的负预测因子。半月板损伤与 RTP 率和职业生涯长度降低相关,但无统计学意义。
结论:本研究中 ACL 重建后的 RTP 率与 NFL 球员报道的相似。MCL 损伤是 RTP 的负预测因子。半月板损伤显示 RTP 率和职业生涯长度降低的趋势,但不是显著的预测因子。大部分损伤发生在赛季早期,应进一步研究潜在的预防策略以减少 ACL 损伤。
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