Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan.
Kasugai Joint & Sports Orthopedic Clinic, Kasugai, Japan.
J Knee Surg. 2024 Oct;37(12):856-863. doi: 10.1055/a-2333-1490. Epub 2024 May 24.
In most previous studies investigating return to preinjury level of sport (RTPS) after anterior cruciate ligament reconstruction (ACLR), whether patients continue aiming for RTPS not only before but also after ACLR was unclear because environmental and social factors were not considered. Herein, we aimed to evaluate factors associated with RTPS among athletes who desired to achieve RTPS even after ACLR, excluding patients who no longer desire this goal owing to environmental and social factors. Ninety-two patients who underwent primary double-bundle ACLR with a minimum 2-year follow-up and desired to achieve RTPS before surgery were retrospectively enrolled. Twelve (13%) patients who no longer desired to achieve RTPS after ACLR owing to environmental and social factors were excluded. Sixty-nine patients were included in the final cohort. At the final follow-up, the patients were split into two groups: those who achieved (R group) or did not achieve (N group) RTPS based on patient self-assessment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores were also determined. The anterior tibial translation in the Lachman test and acceleration and external rotational angular velocity (ERAV) in the pivot shift test were measured at the hardware removal operation. Significant differences were observed for preinjury level of sports between the groups ( < 0.05). The rate of RTPS in competitive athletes was lower than that in recreational athletes (20/46: 43% vs. 16/22: 73%; =.037). Lysholm score, KOOS symptom, pain, and quality of life showed higher values in the R group than in the N group ( < 0.050). Acceleration was significantly lower in the R group than in the N group ( = 0.028). Competitive level of sports is a risk factor for failure to achieve RTPS. The postoperative functional outcomes in the group that achieved RTPS showed more favorable results. These results provide important information to enable the surgeons to consider the appropriate surgical plan for competitive athletes who desire to achieve RTPS after ACLR.
在大多数先前研究中，探讨了前交叉韧带重建（ACL）后重返术前运动水平（RTPS）的情况，但由于未考虑环境和社会因素，不清楚患者在 ACL 重建前和重建后是否仍有继续追求 RTPS 的意愿。在此，我们旨在评估那些即使在 ACLR 后仍希望实现 RTPS 的运动员中与 RTPS 相关的因素，排除由于环境和社会因素而不再希望达到这一目标的患者。本研究回顾性纳入了 92 例接受初次双束 ACLR 并随访至少 2 年且术前希望达到 RTPS 的患者。12 例（13%）由于环境和社会因素而在 ACLR 后不再希望达到 RTPS 的患者被排除。最终纳入 69 例患者进入最终队列。在最终随访时，根据患者自我评估，将患者分为两组：达到 RTPS（R 组）或未达到 RTPS（N 组）。还测定了膝关节损伤和骨关节炎评分（KOOS）和 Lysholm 评分。在取除内固定物时，测量了 Lachman 试验中的胫骨前位移和髌股关节不稳试验中的加速和外旋角速度（ERAV）。两组患者的术前运动水平存在显著差异（<0.05）。竞技运动员达到 RTPS 的比例低于娱乐运动员（20/46：43% vs. 16/22：73%；=0.037）。R 组的 Lysholm 评分、KOOS 症状、疼痛和生活质量评分均高于 N 组（<0.050）。R 组的加速明显低于 N 组（=0.028）。竞技运动水平是影响 RTPS 失败的危险因素。达到 RTPS 的患者术后功能结果更好。这些结果为希望在 ACLR 后达到 RTPS 的竞技运动员提供了重要信息，以便外科医生考虑适当的手术计划。
