Khair Michael, Riboh Jonathan, Solis Jaicus, Maurer Jim, Brown J Britt, Vandermeer Robert D, Cooper Daniel E
The Carrell Clinic, Dallas, Texas, USA.
Duke University, Durham, North Carolina, USA.
Orthop J Sports Med. 2020 Oct 22;8(10):2325967120959004. doi: 10.1177/2325967120959004. eCollection 2020 Oct.
The first case series to report on return to play (RTP) in National Football League (NFL) players after primary anterior cruciate ligament (ACL) reconstruction (ACLR) published an RTP rate of 63%. Other studies that have attempted to estimate RTP after ACLR in these elite athletes have been largely based on secondary sources. This study is the second to report the authors' own results in treating ACL injuries in NFL players spanning a study period of 25+ years.
To report the senior authors' experience treating ACL injuries in NFL players as well as revisit the concept of RTP as it is currently used to measure successful surgical outcomes in professional athletes.
Case series; Level of evidence, 4.
A total of 47 NFL players were treated at our institution for knee injuries that included a complete tear of the ACL; of these, 41 were primary ACLR and 6 were revision ACLR. Of the primary ACLRs, 6 were classified as ACL plus additional ligament and 3 were classified as multiligament. Return to game play (RTGP) was defined as returning to play in a regular-season game. Successful return to previous participation (RTPP) was defined as return to a level of participation equal to the level the player had reached before injury. Multivariate analysis was used to assess predictors of successful RTPP.
Using the RTGP criteria proposed by prior authors, the RTGP after primary ACLR was 73%. Using our proposed RTPP criteria, 87.8% of players successfully returned to the same level of participation after primary ACLR. RTGP percentage for all NFL players after ACLR (including multiligament injuries) was 67.6%, and the overall RTPP for those patients was 87.8%. In multivariate analysis, age ≤25 years was predictive of successful RTPP. High draft picks and offensive players played more seasons after primary ACLR. ACL graft rupture occurred in 4.3% of this cohort. Contralateral ACL tear occurred in 8.5%.
Regardless of which definition is used to measure a successful outcome after ACLR surgery, the findings of this study suggest that successful return after primary ACLR in NFL athletes is higher than previously reported. While concomitant reconstruction of a single collateral ligament did not affect RTPP, revision ACLR or bicruciate plus collateral ligament reconstruction was associated with a lower RTPP rate. Age ≤25 years predicted successful RTPP. The risk of a future ACL tear of either knee after index reconstruction was approximately 13%.
首篇报道美国国家橄榄球联盟（NFL）球员初次前交叉韧带重建术（ACLR）后重返赛场（RTP）情况的病例系列文章公布的重返赛场率为63%。其他试图估算这些精英运动员ACLR术后RTP情况的研究大多基于二手资料。本研究是第二篇报告作者自身在长达25年以上的研究期间治疗NFL球员ACL损伤结果的文章。
报告资深作者治疗NFL球员ACL损伤的经验，并重新审视当前用于衡量职业运动员手术成功结果的RTP概念。
病例系列；证据等级，4级。
共有47名NFL球员在我们机构接受了膝关节损伤治疗，其中包括ACL完全撕裂；其中，41例为初次ACLR，6例为翻修ACLR。在初次ACLR病例中，6例被归类为ACL合并其他韧带损伤，3例被归类为多韧带损伤。重返比赛（RTGP）定义为在常规赛中重返赛场。成功恢复到受伤前的参与水平（RTPP）定义为恢复到与受伤前相同的参与水平。采用多变量分析评估成功RTPP的预测因素。
采用先前作者提出的RTGP标准，初次ACLR后的RTGP为73%。采用我们提出的RTPP标准，87.8%的球员在初次ACLR后成功恢复到相同的参与水平。ACLR后所有NFL球员（包括多韧带损伤）的RTGP百分比为67.6%, 这些患者的总体RTPP为87.8%。在多变量分析中，年龄≤25岁是成功RTPP的预测因素。高顺位选秀球员和进攻球员在初次ACLR后征战的赛季更多。该队列中4.3%发生了ACL移植物破裂。对侧ACL撕裂发生率为8.5%。
无论采用哪种定义来衡量ACLR手术后的成功结果，本研究结果表明，NFL运动员初次ACLR后的成功重返率高于先前报道。虽然同时重建单一侧副韧带不影响RTPP，但翻修ACLR或双十字韧带加侧副韧带重建与较低的RTPP率相关。年龄≤25岁预示着RTPP成功。初次重建后任一膝关节未来发生ACL撕裂的风险约为13%。
