Webster Kate E, Feller Julian A, Klemm Haydn J
School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
OrthoSport Victoria, Epworth HealthCare, Melbourne, Victoria, Australia.
Orthop J Sports Med. 2021 Feb 26;9(2):2325967120985636. doi: 10.1177/2325967120985636. eCollection 2021 Feb.
Younger patients are at increased risk for anterior cruciate ligament (ACL) graft rupture and contralateral injury after ACL reconstruction (ACLR). Increasing the amount of time between surgery and the resumption of competitive sport may reduce this risk.
To determine the rates of graft rupture and injury to the contralateral native ACL at 3- to 5-year follow-up in younger patients who were advised to delay a return to competitive sport until 12 months after surgery and compare this with a nondelayed cohort.
Cohort study; Level of evidence, 3.
The primary study cohort consisted of 142 eligible patients aged <20 years when they underwent their first primary ACLR. All were informed about the risk of further injury and advised not to return to competitive sport before 12 months postoperatively. Return-to-sport status and the number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) were determined at 3- to 5-year follow-up and compared with a historic cohort of 299 patients with ACLR who were not advised to delay their return to sport for a set period. The cohorts were then combined, and injury rates were compared between those who returned to sport before and after 12 months postoperatively.
The follow-up rate was 91% (129/142). In the delayed cohort, 63% returned to competitive sport after 12 months (mean, 14 months). Few patients (n = 10) returned before 9 months. In the delayed group, 33% had a subsequent ACL injury; this was not significantly different when compared with the nondelayed group (31% rate), in which a majority (58%) returned to competitive sport before 12 months. Subsequent ACL injury rates were also similar when compared between patients who returned before and after 12 months postoperatively (33% vs 32%, respectively).
At midterm follow-up, the overall rates of subsequent ACL injury were high, even for patients who delayed their return until 12 months after surgery. More research is required to identify strategies to reduce the high reinjury rate in younger athletes.
年轻患者在前交叉韧带（ACL）重建术（ACLR）后发生ACL移植物破裂和对侧损伤的风险增加。增加手术与恢复竞技运动之间的时间可能会降低这种风险。
确定建议推迟恢复竞技运动至术后12个月的年轻患者在3至5年随访时移植物破裂和对侧原生ACL损伤的发生率，并将其与未延迟的队列进行比较。
队列研究；证据等级，3级。
主要研究队列由142例首次接受原发性ACLR时年龄小于20岁的符合条件的患者组成。所有患者均被告知有进一步受伤的风险，并被建议在术后12个月前不要恢复竞技运动。在3至5年随访时确定恢复运动状态和随后ACL损伤（移植物破裂或对侧原生ACL损伤）的数量，并与299例未被建议在规定时间内延迟恢复运动的ACLR患者的历史队列进行比较。然后将队列合并，比较术后12个月之前和之后恢复运动的患者之间的损伤发生率。
随访率为91%（129/142）。在延迟队列中，63%的患者在12个月后（平均14个月）恢复竞技运动。很少有患者（n = 10）在9个月前恢复运动。在延迟组中，33%的患者随后发生ACL损伤；与未延迟组（发生率31%）相比无显著差异，未延迟组中大多数（58%）在12个月前恢复竞技运动。术后12个月之前和之后恢复运动的患者之间的随后ACL损伤发生率也相似（分别为33%和32%）。
在中期随访中，即使是延迟至术后12个月才恢复运动的患者，随后ACL损伤的总体发生率也很高。需要更多研究来确定降低年轻运动员高再损伤率的策略。
