Avans University for Professionals, Breda, the Netherlands.
Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands.
Sports Health. 2023 Nov-Dec;15(6):898-907. doi: 10.1177/19417381221146538. Epub 2023 Jan 30.
Up to 90% of pediatric athletes return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R); however, <50% RTS at the same level and second ACL injury rates are up to 32%.
(1) Determine which physical and patient-reported outcome measures guide clinical decision-making on RTS in pediatric athletes after ACL-R and (2) present a framework with insights from cognitive and neurophysiological domains to enhance rehabilitation outcomes.
PubMed, CINAHL, Embrase, and Cochrane library databases and gray literature.
Data on pediatric (<18 years) ACL-R patients, RTS, tests, and decision-making were reported in 1214 studies. Two authors independently reviewed titles and abstract, excluding 962 studies. Gray literature and cross-reference checking resulted in 7 extra studies for full-text screening of 259 studies. Final data extraction was from 63 eligible studies.
Scoping review.
Level 4.
Details on study population, aims, methodology, intervention, outcome measures, and important results were collected in a data chart.
Studies included 4456 patients (mean age, 14 years). Quadriceps and hamstring strength (n = 25), knee ligament arthrometer (n = 24), and hop tests (n = 22) were the most-reported physical outcome measures guiding RTS in <30% of studies with cutoff scores of limb symmetry index (LSI) ≥85% or arthrometer difference <3 mm. There were 19 different patient-reported outcome measures, most often reporting the International Knee Documentation Committee (IKDC) (n = 24), Lysholm (n = 23), and Tegner (n = 15) scales. Only for the IKDC was a cutoff value of 85% reported.
RTS clearance in pediatric ACL-R patients is not based on clear criteria. If RTS tests were performed, outcomes did not influence time of RTS. Postoperative LSI thresholds likely overestimate knee function since biomechanics are impaired despite achieving RTS criteria. RTS should be considered a continuum, and biomechanical parameters and contextual rehab should be pursued with attention to the individual, task, and environment. There is a need for psychological monitoring of the ACL-R pediatric population.
多达 90%的儿科运动员在前交叉韧带重建（ACL-R）后重返运动（RTS）；然而，<50%以相同水平和第二次 ACL 损伤率高达 32%的运动员重返运动。
（1）确定哪些身体和患者报告的结果衡量标准可指导 ACL-R 后儿科运动员的 RTS 临床决策，（2）提出一个框架，从认知和神经生理领域获得见解，以增强康复效果。
PubMed、CINAHL、Embrase 和 Cochrane 图书馆数据库以及灰色文献。
报告了 1214 项儿科（<18 岁）ACL-R 患者、RTS、测试和决策的数据。两位作者独立审查了标题和摘要，排除了 962 项研究。灰色文献和交叉引用检查导致 7 项额外研究进行了 259 项研究的全文筛选。最终数据提取来自 63 项合格研究。
范围审查。
4 级。
在数据表中收集了有关研究人群、目的、方法、干预、结果衡量标准和重要结果的详细信息。
研究纳入了 4456 名患者（平均年龄 14 岁）。股四头肌和腘绳肌力量（n=25）、膝关节韧带关节测压器（n=24）和跳跃测试（n=22）是指导<30%研究中 RTS 的最常用的身体结果衡量标准，其截距分数为肢体对称性指数（LSI）≥85%或关节测压器差值<3 毫米。有 19 种不同的患者报告的结果衡量标准，最常报告的是国际膝关节文献委员会（IKDC）（n=24）、Lysholm（n=23）和 Tegner（n=15）量表。仅 IKDC 报告了 85%的截距值。
儿科 ACL-R 患者的 RTS 清除率没有明确的标准。如果进行了 RTS 测试，结果并不会影响 RTS 的时间。术后 LSI 阈值可能高估了膝关节功能，因为尽管达到了 RTS 标准，但生物力学仍受损。RTS 应该被视为一个连续体，应该关注个体、任务和环境，追求生物力学参数和情境康复。需要对 ACL-R 儿科人群进行心理监测。
