Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.
Division of Sports Medicine, Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts.
Arthroscopy. 2023 Mar;39(3):790-801.e6. doi: 10.1016/j.arthro.2022.08.038. Epub 2022 Oct 8.
The purpose of this study was to examine the factors commonly used to determine readiness for return to sport (RTS) in the ACL reconstruction (ACL-R) patient population and assess which were most influential to successfully returning to sport and avoiding re-tear.
The PUBMED, EMBASE and Cochrane Library databases were queried for studies related to RTS in ACL-R. Inclusion and exclusion criteria were applied to identify studies with greater than 1-year outcomes detailing the rate of return and re-tear given a described RTS protocol. Data of interest were extracted, and studies were stratified based on level of evidence and selected study features. Meta-analysis or subjective synthesis of appropriate studies was used to assess more than 25 potentially significant variables effecting RTS and re-tear.
After initial search of 1503 studies, 47 articles were selected for inclusion in the final data analysis, including a total of 1432 patients (31.4% female, 68.6% male). A meta-analysis of re-tear rate for included Level of Evidence 1 studies was calculated to be 2.8%. Subgroups including protocols containing a strict time until RTS, strength testing, and ≥2 dynamic tests demonstrated decreased RTS and re-tear heterogeneity from the larger group. Time to RTS, strength testing, dynamic functional testing, and knee stability were also found to be among the most prevalent reported criteria in RTS protocol studies.
This study suggests a multifactorial clinical algorithm for successful evaluation of RTS. The "critical criteria" recommended by the authors to be part of the postoperative RTS criteria include time since surgery of 8 months, use of >2 functional tests, psychological readiness testing, and quadriceps/hamstring strength testing in addition to the modifying patient factors of age and female gender.
Level IV, systematic review of Level I-IV studies.
本研究旨在探讨常用于 ACL 重建（ACL-R）患者群体中决定重返运动（RTS）准备情况的因素，并评估哪些因素对成功重返运动和避免再次撕裂最有影响。
在 PUBMED、EMBASE 和 Cochrane 图书馆数据库中检索与 ACL-R 患者 RTS 相关的研究。应用纳入和排除标准筛选出具有超过 1 年随访结果的研究，详细描述给定的 RTS 方案下的重返运动和再次撕裂的发生率。提取感兴趣的数据，并根据证据水平和选定的研究特征对研究进行分层。使用荟萃分析或适当研究的主观综合评估超过 25 个可能影响 RTS 和再次撕裂的变量。
在最初搜索了 1503 篇研究后，有 47 篇文章被选入最终数据分析，共纳入了 1432 名患者（31.4%为女性，68.6%为男性）。对包括的证据水平为 1 级的研究的再次撕裂率进行了荟萃分析，结果为 2.8%。包括严格的 RTS 时间、力量测试和≥2 项动态测试的方案亚组显示出较大组中 RTS 和再次撕裂的异质性降低。RTS 方案研究中也发现了时间、力量测试、动态功能测试和膝关节稳定性等是最常见的报告标准。
本研究提出了一种多因素临床算法，用于成功评估 RTS。作者建议将“关键标准”纳入术后 RTS 标准，包括手术 8 个月后、使用>2 项功能测试、心理准备测试、股四头肌/腘绳肌力量测试，以及年龄和女性等患者的修正因素。
IV 级，对 I-IV 级研究的系统评价。
