Wright Cynthia J, Robinson Anastasia B J, Waldrop Norman E, Anderson Robert B, Clanton Thomas O
Health Science Department, Whitworth University, Spokane, WA, USA.
Howard Head Sports Medicine, Vail, CO, USA.
Foot Ankle Orthop. 2023 Mar 29;8(1):24730114231160996. doi: 10.1177/24730114231160996. eCollection 2023 Jan.
BACKGROUND: Manuscripts discussing return to play (RTP) following ankle surgery are common. However, the definition for RTP and the method by which it is determined remains unclear. The purpose of this scoping review was to clarify how RTP is defined following ankle surgery in physically active patients, to identify key factors informing RTP decision making (such as objective clinical measures), and make recommendations for future research. METHODS: A scoping literature review was performed in April 2021 using PubMed, EMBASE, and Nursing and Allied Health databases. Thirty studies met inclusion criteria: original research following ankle surgery reporting at least 1 objective clinical test and documentation of RTP. Data were extracted for study methods and outcomes (RTP definition, RTP outcomes, and objective clinical tests). RESULTS: The scoping review found studies on 5 ankle pathologies: Achilles tendon rupture, chronic lateral ankle instability, anterior ankle impingement, peroneal tendon dislocation, and ankle fracture. RTP criteria were not provided in the majority of studies (18/30 studies). In the studies that provided them, the RTP criteria were primarily based on time postsurgery (8/12) rather than validated criteria. Objective clinical outcome measures and patient-reported outcome measures (PROMs) were documented for each surgery when available. Both clinical outcomes and PROMs were typically measured >1 year postsurgery. CONCLUSION: In physically active patients who have had ankle surgery, RTP remains largely undefined and is not consistently based on prospective objective criteria nor PROMS. We recommend standardization of RTP terminology, adoption of prospective criteria for both clinical measures and PROMs to guide RTP decision making, and enhanced reporting of patient data at the time of RTP to develop normative values and determine when the decision to RTP is not safe. LEVEL OF EVIDENCE: Level IV, scoping review.
背景:讨论踝关节手术后重返运动(RTP)的手稿很常见。然而,RTP的定义及其确定方法仍不明确。本范围综述的目的是阐明在身体活跃的患者踝关节手术后如何定义RTP,确定影响RTP决策的关键因素(如客观临床指标),并为未来研究提出建议。 方法:2021年4月使用PubMed、EMBASE以及护理与联合健康数据库进行了范围文献综述。30项研究符合纳入标准:踝关节手术后的原始研究报告至少1项客观临床测试和RTP记录。提取了研究方法和结果(RTP定义、RTP结果和客观临床测试)的数据。 结果:范围综述发现了关于5种踝关节病变的研究:跟腱断裂、慢性外侧踝关节不稳定、前踝关节撞击、腓骨肌腱脱位和踝关节骨折。大多数研究(18/30项研究)未提供RTP标准。在提供标准的研究中,RTP标准主要基于术后时间(8/12)而非经过验证的标准。如有可用数据,会记录每次手术的客观临床结局指标和患者报告结局指标(PROMs)。临床结局和PROMs通常在术后>1年进行测量。 结论:在接受踝关节手术的身体活跃患者中,RTP在很大程度上仍未明确界定,且并非始终基于前瞻性客观标准或PROMs。我们建议对RTP术语进行标准化,采用临床指标和PROMs的前瞻性标准来指导RTP决策,并在RTP时加强患者数据报告,以建立规范值并确定何时RTP决策不安全。 证据水平:IV级范围综述。
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