Glover Mark A, St Jeor Jeffery D, Parikh Nihir, Rider Danielle E, Bullock Garrett S, Trasolini Nicholas A, Waterman Brian R
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.
Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Feb 18;6(3):100911. doi: 10.1016/j.asmr.2024.100911. eCollection 2024 Jun.
To identify prognostic factors associated with a delayed return-to-sport (RTS) time in amateur athletes who return to full participation after a primary isolated anterior cruciate ligament (ACL) reconstruction.
A retrospective review was performed among athletes who underwent ACL reconstruction between October 2014 and October 2021. Inclusion criteria were any amateur athletes with an ACL reconstruction who had a documented RTS and greater than 1-year follow-up. Nonathletes, those with multiligamentous knee injury, and those missing documented RTS timelines were excluded. RTS was defined as participation in athletics at a level equivalent to or greater than the preinjury level participation. Demographic and prognostic factors, including previous knee surgery, meniscal involvement, level of participation, surgical approach, and graft type, were recorded along with RTS time and analyzed via Poisson regression.
In total, 91 athletes, average age 18.8 (± 6.7) years, who underwent ACL reconstruction at a single institution from 2014 to 2021 were identified with an average follow-up time of 4.6 (± 2.5) years (range 1.1, 9.0). Meniscal involvement (1.11; 95% confidence interval [CI] 1.08-1.15, < .001) and previous knee surgery (1.43; 95% CI 1.29-1.58; < .001) were related to a delayed RTS. Quadriceps tendon and bone-patellar tendon-bone autografts, as well as allograft, showed a significant association with a longer RTS time when compared with hamstring autograft (1.16, 95% CI 1.13-1.20, < .001; 1.04, 95% CI 1.01-1.07, = .020; 1.11, 95% CI 1.03-1.19, = .004, respectively), as did anteromedial portal drilling, when compared with the outside in approach for femoral drilling (1.19, 95% CI 1.16-1.23, < .001).
Previous knee surgery, anteromedial femoral drilling, quadriceps tendon autograft, and meniscus tear were most associated with a delayed timeline for RTS among young athletes who were able to return.
Level IV, prognostic case series.
确定在初次单纯前交叉韧带（ACL）重建后恢复全面运动的业余运动员中，与运动恢复延迟（RTS）时间相关的预后因素。
对2014年10月至2021年10月期间接受ACL重建的运动员进行回顾性研究。纳入标准为任何接受过ACL重建且有记录的RTS且随访时间超过1年的业余运动员。排除非运动员、多韧带膝关节损伤患者以及缺少记录的RTS时间线的患者。RTS定义为参与与伤前同等水平或更高水平的运动。记录人口统计学和预后因素，包括既往膝关节手术、半月板损伤情况、运动参与水平、手术入路和移植物类型，并记录RTS时间，通过泊松回归进行分析。
总共确定了91名运动员，平均年龄18.8（±6.7）岁，他们于2014年至2021年在单一机构接受了ACL重建，平均随访时间为4.6（±2.5）年（范围1.1至9.0年）。半月板损伤（1.11；95%置信区间[CI]1.08 - 1.15，P <.001）和既往膝关节手术（1.43；95%CI 1.29 - 1.58；P <.001）与RTS延迟有关。与腘绳肌自体移植物相比，股四头肌腱和髌腱 - 骨自体移植物以及同种异体移植物与更长的RTS时间显著相关（分别为1.16，95%CI 1.13 - 1.20，P <.001；1.04，95%CI 1.01 - 1.07，P =.020；1.11，95%CI 1.03 - 1.19，P =.004），与股骨钻孔的外侧入路相比，前内侧入路钻孔也是如此（1.19，95%CI 1.16 - 1.23，P <.001）。
既往膝关节手术、股骨前内侧钻孔、股四头肌腱自体移植物和半月板撕裂与能够恢复运动的年轻运动员中RTS时间延迟最为相关。
IV级，预后病例系列。
