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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Current Return to Sport Criteria after ACL Reconstruction Fail to Identify Increased Risk of Second ACL Injury in Young Athletes
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Current Return to Sport Criteria after ACL Reconstruction Fail to Identify Increased Risk of Second ACL Injury in Young Athletes

机译：ACL重建后当前的运动标准返回未能确定年轻运动员第二ACL损伤的风险增加

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Objectives: The incidence of 2nd anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) and return to sport (RTS) ranges from 25%-33% in young, active populations; with the greatest risk in the first 12 months after RTS. Recent data indicate that failure to successfully meet traditional RTS criteria, inclusive of strength, functional hop testing and patient reported outcome scores, may identify athletes at increased risk of future injury after ACLR. However, these studies have focused on adult populations and it is unknown if similar RTS criteria apply to young, adolescent, pivoting/cutting athletes. The purpose of this study was to determine if meeting all current, standard RTS criteria would identify young athletes at risk for future ACL injury after primary ACLR and RTS. The tested hypothesis was the likelihood of 2~(nd)ACL injury in the first 2 years after RTS would be lower in patients who met all RTS criteria prior to initiation of pivoting and cutting activity compared to patients who failed to meet all RTS criteria prior to RTS. Methods: One hundred fifty-nine subjects (112 female, 47 male) with a mean age of 17.2±2.6 years old (range: 13-25 y.o.) underwent ACLR and were released to return to pivoting/cutting sport. These patients were enrolled in a prospective, observational cohort study, completed a RTS assessment and were then tracked for occurrence of 2~(nd)ACL after ACLR for 24 months. The RTS assessment included 6 tests: isometric quadriceps strength, 4 functional hop tests and the International Knee Documentation Committee (IKDC) patient reported outcome survey. Limb symmetry index (LSI) was calculated for strength and hop test assessments [(involved/uninvolved)*100]. The IKDC was reported on a 0-100 scale with 100 representing a perfect score. Subjects were classified into groups that successfully passed all 6 RTS tests at a level of 90 and again at 95 compared to those that failed to meet all 6 criteria. Chi Square tests were used to determine if successfully passing all 6 RTS measures at various levels of symmetry resulted in a reduced risk of 2~(nd)ACL injury in the first 24 months after RTS. Results: Thirty-five (22.0%) patients suffered a 2~(nd)ACL injury, with 26 occurring in the first 12 months after RTS. At the time of RTS, 42 patients (26%) achieved LSI values of 90 or greater on all testing as well as an IKDC value of 90 or greater. The remaining 117 subjects (74%) scored below 90 on at least 1 of the 6 assessments. At this level, there was no difference in 2~(nd)ACL injury prevalence between patients who passed all RTS criteria (12/42; 28.6%) and those who failed at least 1 criteria (23/117; 19.7%) (p=0.23). When the passing criteria was elevated to 95 on all RTS testing, only 15 subjects (9%) successfully passed all 6 tests. There was no significant difference in 2~(nd)ACL injury prevalence between patients who passed all RTS criteria (5/15; 33%) and those who failed at least 1 test (30/144; 20.8%) (p=0.32). Sub-group analysis which evaluated the group by graft type, also indicated no significant differences between groups (p>0.05). Conclusion: Current criteria to evaluate readiness to return young athletes to pivoting and cutting sports, using quadriceps strength symmetry, functional hop performance symmetry and patient reported outcomes, may not identify young, active patients at high risk for 2~(nd)ACL injury. Future work must identify more appropriate criteria to assess readiness to RTS in the young, athletic population and incorporate these findings into practice.
机译：目的：在年轻活跃的人群中，进行ACL重建（ACLR）和恢复运动（RTS）后第二前交叉韧带（ACL）损伤的发生率在25％-33％之间;在RTS之后的前12个月内风险最高。最近的数据表明，未能成功达到传统的RTS标准，包括力量，功能性跳步测试和患者报告的结果评分，可能会识别出ACLR以后受伤风险增加的运动员。但是，这些研究集中在成人人群上，尚不清楚类似的RTS标准是否适用于年轻，青少年，枢纽运动/切割运动员。这项研究的目的是确定是否满足所有当前的标准RTS标准，即可确定在初次ACLR和RTS后有未来ACL受伤风险的年轻运动员。检验的假设是，在开始旋转和切割活动之前满足所有RTS标准的患者，与之前未满足所有RTS标准的患者相比，RTS后最初2年发生2〜（A）ACL损伤的可能性更低侵权行为。方法：159名平均年龄为17.2±2.6岁（范围：13-25岁）的受试者（112岁，男性47岁）接受了ACLR训练，并被释放以恢复旋转/切割运动。这些患者参加了一项前瞻性观察性队列研究，完成了RTS评估，然后追踪ACLR治疗24个月后发生2〜（A）ACL。 RTS评估包括6个测试：等长四头肌力量，4个功能跳跃测试和国际膝关节文献委员会（IKDC）患者报告的结果调查。计算肢体对称指数（LSI），以进行强度和啤酒花测试评估[（涉及/不涉及）* 100]。 IKDC的评分范围为0-100，满分为100。与未达到所有6个标准的受试者相比，将受试者分为成功通过所有6项RTS测试（分别为90和95）的组。卡方检验用于确定在对称性水平成功通过所有6种RTS措施后，是否在对称性的各个水平上均成功降低了2〜（nd）ACL损伤的风险。结果：35例（22.0％）患者遭受了2〜ACL损伤，其中26例发生在RTS后的前12个月。在进行RTS时，有42位患者（26％）在所有测试中的LSI值均达到90或更高，IKDC值达到90或更高。其余117名受试者（74％）在6项评估中至少有1项得分低于90。在此水平上，通过所有RTS标准的患者（12/42; 28.6％）与未通过至少1个标准的患者（23/117; 19.7％）之间的2〜（A）ACL损伤患病率无差异（p = 0.23）。当所有RTS测试的通过标准提高到95时，只有15位受试者（9％）成功通过了全部6项测试。通过所有RTS标准的患者（5/15; 33％）与未通过至少1项测试的患者（30/144; 20.8％）之间的2〜（n）ACL损伤患病率无显着差异（p = 0.32） 。按移植类型评估组的亚组分析也表明，各组之间无显着差异（p> 0.05）。结论：使用四头肌力量对称性，功能跳跃性能对称性和患者报告的结果来评估使年轻运动员重返轮滑和切割运动的准备程度的当前标准，可能无法识别出处于2〜（n）ACL损伤高风险的年轻活跃患者。未来的工作必须确定更合适的标准，以评估年轻运动人群的RTS准备情况，并将这些发现纳入实践。

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