van Melick Nicky, Pronk Yvette, Nijhuis-van der Sanden Maria, Rutten Sebastiaan, van Tienen Tony, Hoogeboom Thomas
Research Department, Kliniek ViaSana, Mill, The Netherlands.
KneeSearch, Heesch, The Netherlands.
J Orthop Res. 2022 Jan;40(1):117-128. doi: 10.1002/jor.25017. Epub 2021 Mar 11.
The purposes of this prospective cohort study were (1) to assess if second anterior cruciate ligament (ACL) injury rate 2 years after ACL reconstruction (ACLR) in those who returned to pivoting sport was associated with meeting (a) quantitative return to sport (RTS) criteria, (b) qualitative RTS criteria, and (c) combined quantitative and qualitative RTS criteria, and (2) to determine why athletes did not return to their preinjury (level of) sport. Athletes after ACLR performed RTS tests immediately before RTS: seven movement quantity (strength and hop test battery) and two movement quality (countermovement jump with LESS score and hop-and-hold test) tests. A 2-year postoperative questionnaire asked for RTS, reasons for not returning to the same (level of) sport and second ACL injuries. One hundred and forty-four athletes (82%) completed the questionnaire and 97 of them returned to a pivoting sport. Seven of these athletes had a second ACL injury. Meeting the hop test battery RTS criterion (absolute risk reduction 11%; p = .047) and hop-and-hold test RTS criterion (absolute risk reduction 15%; p = .031) were both significantly associated with a reduced second ACL injury rate. Meeting combined RTS criteria were not significantly associated with second ACL injury rate. Therefore, RTS tests after ACLR should at least comprise a hop test battery or the hop-and-hold test to reduce second ACL injury risk after return to pivoting sport. Also, one-third of all athletes mentioned fear of reinjury as the main reason for not returning to their preinjury (level of) sport. This psychological component should be taken seriously and discussed during rehabilitation.
（1）评估前交叉韧带（ACL）重建（ACLR）后2年，恢复旋转运动的患者二次ACL损伤率是否与满足以下条件相关：（a）定量恢复运动（RTS）标准；（b）定性RTS标准；（c）定量与定性相结合的RTS标准；（2）确定运动员未恢复到伤前运动水平的原因。ACLR后的运动员在恢复运动前立即进行RTS测试：七项运动数量测试（力量和跳跃测试组）和两项运动质量测试（使用LESS评分的反向跳跃和单腿跳-保持测试）。术后2年的问卷调查询问了恢复运动情况、未恢复到相同运动水平的原因以及二次ACL损伤情况。144名运动员（82%）完成了问卷调查，其中97人恢复了旋转运动。这些运动员中有7人发生了二次ACL损伤。满足跳跃测试组RTS标准（绝对风险降低11%；p = 0.047）和单腿跳-保持测试RTS标准（绝对风险降低15%；p = 0.031）均与二次ACL损伤率降低显著相关。满足综合RTS标准与二次ACL损伤率无显著相关性。因此，ACLR后的RTS测试应至少包括跳跃测试组或单腿跳-保持测试，以降低恢复旋转运动后二次ACL损伤的风险。此外，所有运动员中有三分之一提到害怕再次受伤是未恢复到伤前运动水平的主要原因。在康复过程中应认真对待并讨论这一心理因素。
