Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Am J Sports Med. 2021 May;49(6):1421-1430. doi: 10.1177/0363546521999109. Epub 2021 Apr 15.
The risk of a second anterior cruciate ligament (ACL) injury when participating in pivoting sports after ACL reconstruction is high. Risk factors associated with a second ACL injury are complex.
To investigate the combinations of various clinical risk factors associated with second ACL injury in female soccer players with a primary unilateral ACL reconstruction, using Classification and Regression Tree (CART) analysis.
Cohort study; Level of evidence, 2.
A total of 117 active female soccer players (mean ± SD age, 20 ± 2 years) were included. Athletes were enrolled 19 ± 9 months after ACL reconstruction and were prospectively followed for 2 years. At baseline, all players underwent assessment of knee and ankle joint range of motion (ROM), participated in functional tests (postural control, hop performance, and movement asymmetries in the lower limbs and trunk), and answered questionnaires (patient-reported knee function, knee-related quality of life, psychological and personality factors). A clinical prediction model using CART was developed.
A total of 28 players (24%) sustained a second ACL injury (21 ipsilateral and 7 contralateral ruptures) while playing soccer. CART analysis selected 9 of 19 independent variables associated with second ACL injury: the 5-jump test, knee collapse on the non-ACL reconstructed leg in a drop vertical jump, tuck jump, limb symmetry index on side hop and the single hop for distance, side difference in ankle dorsiflexion ROM, and scores for the questionnaires ACL-Return to Sport After Injury and the Swedish Universities Scales of Personality subscales of Stress Susceptibility and Adventure Seeking. The accuracy of the model was 89%, with 100% sensitivity and 76% specificity. CART analysis indicated that the interaction of longer jumps in the 5-jump test (>916 cm) with more side difference in ankle dorsiflexion ROM (>-2.5°) and more knee valgus collapse in the nonreconstructed knee (>-1.4 cm) (relative risk, 4.03; 95% CI, 2.21-7.36) best predicted an increased likelihood of a second ACL injury.
The risk profiles selected by CART could accurately identify female soccer players at high risk for a second ACL injury. There was an interaction between functional performance, clinical assessment, and psychological factors, and it is reasonable to include these factors in return-to-sport decisions and in athlete screening after ACL injury.
前交叉韧带（ACL）重建后参与旋转运动时发生二次 ACL 损伤的风险很高。与 ACL 再损伤相关的风险因素较为复杂。
使用分类回归树（CART）分析，研究初次单侧 ACL 重建后女性足球运动员中与二次 ACL 损伤相关的各种临床风险因素的组合。
队列研究；证据水平，2 级。
共纳入 117 名活跃的女性足球运动员（平均±标准差年龄为 20±2 岁）。运动员在 ACL 重建后 19±9 个月入组，并进行了 2 年的前瞻性随访。在基线时，所有运动员均接受膝关节和踝关节活动范围（ROM）评估、功能测试（姿势控制、跳跃表现和下肢及躯干的运动不对称性）和问卷调查（患者报告的膝关节功能、膝关节相关生活质量、心理和人格因素）。使用 CART 建立临床预测模型。
共有 28 名运动员（24%）在踢足球时发生了二次 ACL 损伤（21 例同侧和 7 例对侧撕裂）。CART 分析选择了与二次 ACL 损伤相关的 19 个独立变量中的 9 个变量：5 次跳跃测试、非 ACL 重建侧在垂直跳下落时的膝关节塌陷、纵跳、侧跳和单足跳的下肢对称性指数、踝关节背屈 ROM 的侧方差异以及 ACL 损伤后重返运动问卷和瑞典大学人格量表压力易感性和冒险寻求亚量表的得分。该模型的准确率为 89%，敏感度为 100%，特异度为 76%。CART 分析表明，5 次跳跃测试中跳跃距离较长（>916cm）与非重建侧踝关节背屈 ROM 的侧方差异较大（>-2.5°）和非重建侧膝关节外翻塌陷较大（>-1.4cm）之间的相互作用（相对风险，4.03；95%CI，2.21-7.36）最佳预测二次 ACL 损伤的可能性增加。
CART 选择的风险特征可以准确识别二次 ACL 损伤风险较高的女性足球运动员。功能表现、临床评估和心理因素之间存在相互作用，因此在重返运动决策和 ACL 损伤后运动员筛查中纳入这些因素是合理的。
