School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia.
Private orthopaedic and physical therapy practice, Sunshine Coast, Australia.
Am J Sports Med. 2022 Mar;50(4):912-921. doi: 10.1177/03635465211073152. Epub 2022 Feb 11.
Reconstruction is considered to provide the best opportunity for return to sports (RTS) after anterior cruciate ligament (ACL) rupture. However, recent studies report that <50% of athletes return to preinjury sporting levels and that RTS rates at 1 year after injury are the same for athletes undergoing reconstruction and nonoperative management. Long-term studies are essential to confirm these findings and guide decisions regarding surgery.
First, to compare long-term sports participation after ACL reconstruction and nonreconstruction and, second, to relate RTS level to strength and stability.
Cohort study; Level of evidence, 3.
Patients with ACL deficiency (n = 101) who were referred for physical therapy at the time of diagnosis were followed long term: 56 were treated surgically 2.5 years (interquartile range [IQR], 1-4) after injury and 45 were treated nonoperatively. At long-term follow-up, the reconstructed group was at 9 years (IQR, 7-11) after injury and aged 33.3 ± 6.2 years (mean ± SD, 70% male; 61% meniscal injury), and the nonreconstructed group was at 11 years (IQR, 7-14) after injury and aged 38.7 ± 8.3 years (67% male; 58% meniscal injury). Measures of objective stability, subjective stability, and quadriceps/hamstring strength were compared between groups using independent-samples tests. Current RTS level, scored on a 6-point scale, was compared between groups using chi-square tests. Spearman rho correlated RTS with outcome measures.
Of the total group of patients, 96% with reconstruction and 93% without continued to play sports. In the reconstructed and nonreconstructed groups, 4% and 7% did not RTS, and 8% and 17% returned to safe sports, respectively: 13% and 12% to running, 20% and 26% to sports involving limited twisting, 12% and 24% to recreational pivoting sports, and 43% and 14% to competitive pivoting sports. The only significant difference was in return to competitive pivoting sports ( = .003). Five patients with reconstruction ruptured the contralateral ACL, and 1 ruptured his graft. Most patients treated nonoperatively modified their sports participation. Their RTS levels correlated significantly with quadriceps strength ( = 0.65; < .001), hamstring strength ( = 0.721; < .001), and subjective stability ( = 0.405; = .01).
Surgically treated patients returned to competitive pivoting sports at 3 times the rate of those managed nonoperatively, confirming that reconstruction provides the best opportunity for continued participation in competitive pivoting sports. Regardless of grouping, RTS correlated with modifiable factors, including strength and stability. Higher rates of subsequent injuries observed after reconstruction may result from increased participation in competitive pivoting sports.
重建被认为是在前交叉韧带（ACL）断裂后恢复运动（RTS）的最佳机会。然而，最近的研究报告称，<50%的运动员能恢复到受伤前的运动水平，而且在受伤后 1 年，接受重建和非手术治疗的运动员的 RTS 率相同。长期研究对于证实这些发现和指导手术决策至关重要。
首先，比较 ACL 重建和非重建后的长期运动参与情况，其次，将 RTS 水平与力量和稳定性相关联。
队列研究；证据水平，3 级。
在诊断时转诊至物理治疗的 ACL 缺陷患者（n=101）进行了长期随访：2.5 年（四分位距[IQR]，1-4）后，56 例接受手术治疗，45 例接受非手术治疗。在长期随访中，重建组在受伤后 9 年（IQR，7-11），年龄为 33.3±6.2 岁（均值±标准差，70%为男性；61%半月板损伤），而非重建组在受伤后 11 年（IQR，7-14），年龄为 38.7±8.3 岁（67%为男性；58%半月板损伤）。使用独立样本 t 检验比较两组之间的客观稳定性、主观稳定性和股四头肌/腘绳肌力量测量值。使用卡方检验比较两组之间当前的 RTS 水平（6 分制评分）。Spearman rho 相关性分析将 RTS 与结局测量值相关联。
在所有患者中，96%接受重建和 93%未接受重建的患者继续进行运动。在重建组和非重建组中，4%和 7%的患者未恢复 RTS，分别有 8%和 17%的患者恢复安全运动，分别为 13%和 20%的患者恢复跑步运动，20%和 26%的患者恢复有限扭转运动，12%和 24%的患者恢复娱乐性枢轴运动，43%和 14%的患者恢复竞技性枢轴运动。唯一显著的差异是在恢复竞技性枢轴运动方面（=0.003）。5 名接受重建的患者对侧 ACL 断裂，1 名患者的移植物断裂。大多数接受非手术治疗的患者改变了他们的运动参与方式。他们的 RTS 水平与股四头肌力量（=0.65；<0.001）、腘绳肌力量（=0.721；<0.001）和主观稳定性（=0.405；=0.01）显著相关。
手术治疗的患者恢复竞技性枢轴运动的比例是接受非手术治疗患者的 3 倍，证实了重建为继续参加竞技性枢轴运动提供了最佳机会。无论分组如何，RTS 与可改变的因素（包括力量和稳定性）相关。重建后观察到的后续损伤率较高可能是由于参加竞技性枢轴运动的人数增加所致。
