Filbay Stephanie R, Bullock Garrett, Russell Scott, Brown Frances, Hui Wilson, Egerton Thorlene
Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Level 7, Alan Gilbert Building, Melbourne, VIC, 3010, Australia.
Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Sports Med. 2025 Jul 2. doi: 10.1007/s40279-025-02268-5.
A common belief amongst patients and clinicians is that anterior cruciate ligament reconstruction is required to return to sport. It is not clear if this belief is supported by the best available research.
We aimed to compare return-to-sport and activity levels following anterior cruciate ligament rupture managed with anterior cruciate ligament reconstruction versus rehabilitation alone.
We performed a systematic review and meta-analysis. A comprehensive search was conducted across seven electronic databases for empirical studies published to July 2023. Articles were included if they assessed return-to-sport and/or activity levels in two groups where one underwent an anterior cruciate ligament reconstruction and the other had exercise-based rehabilitation that was standardised and/or supervised by a healthcare professional. In addition to narrative syntheses, random-effect meta-analyses were conducted for return-to-sport and activity participation (Tegner Activity Scale). The protocol was pre-registered (PROSPERO CRD42022313507).
Eighteen articles reporting on 15 studies (two randomised controlled trials) met inclusion criteria. Ten studies had a high risk of confounding bias that was likely to favour anterior cruciate ligament reconstruction including biases in group allocation and differences in activity and return-to-sport advice between groups. The findings suggest that anterior cruciate ligament reconstruction was not associated with higher return-to-sport rates (odds ratio 1.5, 95% confidence interval 0.76-2.97) compared to rehabilitation alone. A small difference favouring anterior cruciate ligament reconstruction was observed for Tegner Activity Scale scores (mean difference 0.7, 95% confidence interval 0.16-1.24) that did not exceed the minimal detectable change and no difference was observed after excluding studies with a high risk of confounding bias. Insufficient data were available for time to return to sport and physical activity levels. The evidence is of low or very low certainty because of the heterogeneity of results and the high risk of bias in the included studies.
There was no difference in return-to-sport rates or activity levels when comparing anterior cruciate ligament reconstruction with rehabilitation alone for the management of anterior cruciate ligament injury.
患者和临床医生普遍认为，前交叉韧带重建是恢复运动所必需的。目前尚不清楚这一观点是否得到了现有最佳研究的支持。
我们旨在比较前交叉韧带重建与单纯康复治疗前交叉韧带断裂后恢复运动和活动水平的情况。
我们进行了一项系统评价和荟萃分析。对七个电子数据库进行了全面检索，以查找截至2023年7月发表的实证研究。如果文章评估了两组的恢复运动和/或活动水平，其中一组接受了前交叉韧带重建，另一组接受了由医疗保健专业人员标准化和/或监督的基于运动的康复治疗，则纳入该文章。除了叙述性综合分析外，还对恢复运动和活动参与情况（Tegner活动量表）进行了随机效应荟萃分析。该方案已预先注册（PROSPERO CRD42022313507）。
18篇报告15项研究（两项随机对照试验）的文章符合纳入标准。十项研究存在高度混杂偏倚风险，可能有利于前交叉韧带重建，包括组间分配偏倚以及活动和恢复运动建议的差异。研究结果表明，与单纯康复治疗相比，前交叉韧带重建与更高的恢复运动率无关（优势比1.5，95%置信区间0.76 - 2.97）。在Tegner活动量表评分方面观察到有利于前交叉韧带重建的微小差异（平均差异0.7，95%置信区间0.16 - 1.24），但未超过最小可检测变化，排除具有高度混杂偏倚风险的研究后未观察到差异。恢复运动时间和身体活动水平的数据不足。由于结果的异质性和纳入研究中的高偏倚风险，证据的确定性为低或非常低。
在前交叉韧带损伤的治疗中，将前交叉韧带重建与单纯康复治疗进行比较时，恢复运动率或活动水平没有差异。
