Knee and Sports Research Group, Federal University of Ceará, Fortaleza, Brazil.
Master Program in Physiotherapy and Functioning, Federal University of Ceará, Fortaleza, Brazil.
J Athl Train. 2020 Jul 1;55(7):691-698. doi: 10.4085/1062-6050-82-19.
CONTEXT: Understanding the factors that predict return to sport (RTS) after anterior cruciate ligament reconstruction facilitates clinical decision making. OBJECTIVE: To develop a clinical decision algorithm that could predict RTS and non-RTS based on the differences in the variables after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 150 athletes in any sport involving deceleration, jumping, cutting, or turning enrolled in the study. All participants answered the International Knee Documentation Committee and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) questionnaires and performed balance and isokinetic tests. MAIN OUTCOME MEASURE(S): The classification and regression tree (CART) was used to determine the clinical decision algorithm associated with RTS at any level and RTS at the preinjury level. The diagnostic accuracy of the CART was verified. RESULTS: Of the 150 participants, 57.3% (n = 86) returned to sport at any level and 12% (n = 18) returned to sport at the preinjury level. The interactions among the peak torque extension at 300°/s >93.55 Nm, ACL-RSI score >27.05 (P = .06), and postoperative time >7.50 months were associated with RTS at any level identified by CART and were factors associated with RTS. An ACL-RSI score >72.85% was the main variable associated with RTS at the preinjury level. The interaction among an ACL-RSI score of 50.40% to 72.85%, agonist : antagonist ratio at 300°/s ≤63.6%, and anteroposterior stability index ≤2.4 in these participants was the second factor associated with RTS at the preinjury level. CONCLUSIONS: Athletes who had more quadriceps strength tended to RTS at any level more quickly, even with less-than-expected psychological readiness. Regarding a return at the preinjury level, psychological readiness was the most important factor in not returning, followed by a better agonist : antagonist ratio and better balance.
背景:了解预测前交叉韧带重建后重返运动(RTS)的因素有助于临床决策。 目的:制定一种临床决策算法,根据前交叉韧带重建后变量的差异,预测 RTS 和非 RTS。 设计:横断面研究。 设置:大学实验室。 患者或其他参与者:共有 150 名从事减速、跳跃、切割或转弯等运动的运动员参与了这项研究。所有参与者均回答了国际膝关节文献委员会和前交叉韧带损伤后重返运动的评估(ACL-RSI)问卷,并进行了平衡和等速测试。 主要观察指标:分类回归树(CART)用于确定与任何水平和受伤前水平 RTS 相关的临床决策算法。验证了 CART 的诊断准确性。 结果:在 150 名参与者中,57.3%(n=86)在任何水平上重返运动,12%(n=18)在受伤前水平上重返运动。300°/s 时的峰值扭矩伸膝>93.55 Nm、ACL-RSI 评分>27.05(P=0.06)和术后时间>7.50 个月之间的相互作用与 CART 确定的任何水平的 RTS 相关,是 RTS 的相关因素。ACL-RSI 评分>72.85%是与受伤前水平 RTS 相关的主要变量。在这些参与者中,ACL-RSI 评分为 50.40%至 72.85%、300°/s 时的收缩/拮抗比值≤63.6%和前后稳定性指数≤2.4 之间的相互作用是与受伤前水平 RTS 相关的第二个因素。 结论:股四头肌力量较强的运动员往往会更快地在任何水平上恢复运动,即使他们的心理准备程度低于预期。至于恢复到受伤前的水平,心理准备是最重要的因素,其次是更好的收缩/拮抗比值和更好的平衡。
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