Haraldsplass Deaconess Hospital, Bergen, Norway.
University of Bergen, Bergen, Norway.
Am J Sports Med. 2021 Apr;49(5):1236-1243. doi: 10.1177/0363546521991924. Epub 2021 Mar 3.
Knowledge about the predictive value of return to sport (RTS) test batteries applied after anterior cruciate ligament reconstruction (ACLR) is limited. Adding assessment of psychological readiness has been recommended, but knowledge of how this affects the predictive ability of test batteries is lacking.
To examine the predictive ability of a RTS test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated.
Cohort study; Level of evidence, 2.
A total of 129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury. Patients with concomitant ligamentous surgery or ACL revision surgery were excluded. Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test. At a 2-year follow-up evaluation, further knee surgery and reinjuries were registered and the RTS questionnaire was completed again. Regression analyses and receiver operating characteristic analyses were performed to study the predictive ability of the test battery.
Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport. ACL-RSI 9 months after surgery (odds ratio [OR], 1.03) and age (OR, 1.05) predicted RTS. An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport (area under the curve 0.69; 95% CI, 0.58-0.79), with 85% sensitivity and 45% specificity. The functional tests did not predict RTS. Six patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing. None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury.
ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.
关于前交叉韧带重建（ACL）后恢复运动（RTS）测试的预测价值的知识有限。有人建议增加对心理准备的评估，但缺乏关于这如何影响测试的预测能力的知识。
当评估心理准备时，检查 RTS 测试对返回术前运动水平和再损伤的预测能力。
队列研究；证据水平，2。
共招募了 129 例 ACL 后 9 个月的患者。纳入标准为年龄≥16 岁且受伤前从事运动。排除同时进行韧带手术或 ACL 翻修手术的患者。基线测试包括单腿跳跃测试、等速力量测试、国际膝关节文献委员会（IKDC）主观膝关节 2000 表单、定制的 RTS 问卷和前交叉韧带损伤后重返运动（ACL-RSI）量表。RTS 标准为 IKDC 2000 评分≥85%，跳跃和力量测试的腿对称指数≥85%。在 2 年随访评估时，记录了进一步的膝关节手术和再损伤，并再次完成 RTS 问卷。进行回归分析和接收者操作特征分析，以研究测试组合的预测能力。
在完成 2 年随访的 103 例患者中，42%恢复到术前运动水平。术后 9 个月的 ACL-RSI（优势比[OR]，1.03）和年龄（OR，1.05）预测 RTS。ACL-RSI 评分<47 表明患者有无法重返运动的风险（曲线下面积 0.69；95%CI，0.58-0.79），敏感性为 85%，特异性为 45%。功能测试不能预测 RTS。6 例患者 ACL 再受伤，7 例患者 RTS 测试后因其他膝关节问题/受伤接受手术。在通过所有 RTS 标准的 29 例患者中，没有 1 例发生第二次膝关节损伤，这些患者因此被清除了 RTS 标准。
ACL-RSI 和年龄是 2 年 RTS 的预测因素，而功能测试没有提供信息。另一个主要发现是，通过 85%RTS 标准的患者无一例发生另一次膝关节损伤。
