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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >HEALTHY PEDIATRIC ATHLETES HAVE SIGNIFICANT BASELINE LIMB ASYMMETRIES ON COMMON RETURN TO SPORT PERFORMANCE TESTS
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HEALTHY PEDIATRIC ATHLETES HAVE SIGNIFICANT BASELINE LIMB ASYMMETRIES ON COMMON RETURN TO SPORT PERFORMANCE TESTS

机译：健康的小儿运动员在共同返回运动成绩测试时具有明显的基线肢体不对称

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Purpose/Hypothesis: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction in children is associated with a much higher risk (?30%) of subsequent ACL injury than in adults. Most RTS testing protocols use Limb Symmetry Indices (LSI) on physical performance tests (PPTs). This assumes that both lower extremities should be equal. We hypothesized that in the pediatric population, baseline limb asymmetry exists, limiting the clinical utility of LSIs. Since LSI & 90% is often used as a clinical cutoff for RTS, we defined a test as valid if 80% of healthy volunteers had an LSI & 90%. Number of Subjects: 63 Materials/Methods: This study included healthy volunteers ages 6-18 [mean age = 10.7 +/- 3.2 years; 34 females (54%)]. Pubertal Maturity Observation Scores (PMOS), sex, age, height, weight, and body mass index (BMI) were collected. Subjects performed ten PPTs: lower quarter Y-balance, stork balance, stork balance on BOSU, single leg squat (SLS), SLS on BOSU, clockwise and counterclockwise quadrant single leg hop (SLH), forward SLH, timed SLH, and triple crossover SLH. Subjects performed the items in the same order, but were randomly assigned the starting test and the starting limb. We developed a composite score for each limb by averaging trials, then calculated the absolute value of the side-to-side difference, and normalized this difference to the test mean to obtain a percentage side-to-side difference (%STS). Multivariable linear regression analysis was performed to assess the effect of age on limb symmetry while correcting for BMI, PMOS and sex. Results: %STS were not normally distributed for any PPT, therefore data were reported as medians and interquartile ranges. All PPTs showed baseline limb asymmetry, and none met our definition of validity. The most symmetric PPT was the clockwise quadrant hop test (%STS in females, median = 9.85, interquartile range = 4.63 – 18.7; %STS in males, median = 6.9, interquartile range = 3.64 – 14.04). The stork balance on BOSU test had the greatest limb asymmetry (%STS in females, median 41.4, interquartile range 10.1 – 71.3; %STS in males, median 47.6, interquartile range 18.2 – 66.7). PMOS was strongly correlated with age (Pearson’s? = 0.83), and was excluded as a predictor variable. Age was an independent predictor of %STS only for the stork test (B = -1.15, 95% CI = -1.92 to -0.38, p = 0.004), with older subjects having less limb asymmetry. Conclusions: Healthy children have significant baseline limb asymmetries on PPTs that are commonly used for RTS decision making after ACL reconstruction. None of the PPTs evaluated in this study met our definition of clinical validity. Limb symmetry was typically not affected by subject age. Clinical Relevance: In light of these results, limb symmetry indices (LSI) should be utilized with caution in this population. Functional recovery may be better assessed by comparison to age and sex-specific norms. Figure 2. BOSU Stork Test Limb Symmetry
机译：目的/假设：儿童前十字韧带（ACL）重建后重返运动（RTS）与成人相比，其后续ACL受伤的风险高得多（？30％）。大多数RTS测试协议在物理性能测试（PPT）上使用肢体对称指数（LSI）。假设两个下肢应该相等。我们假设在儿科人群中存在基线肢体不对称，限制了LSI的临床应用。由于LSI＆ 90％通常用作RTS的临床临界值，如果80％的健康志愿者的LSI> 90％。受试者人数：63资料/方法：本研究纳入6-18岁的健康志愿者[平均年龄= 10.7 +/- 3.2岁; 34位女性（54％）]。收集青春期成熟度观察评分（PMOS），性别，年龄，身高，体重和体重指数（BMI）。受试者进行了十次PPT：下四分之一的Y平衡，鹳平衡，BOSU上的鹳平衡，单腿下蹲（SLS），BOSU上的SLS，顺时针和逆时针象限单腿跳（SLH），正向SLH，定时SLH和三重交叉SLH。受试者以相同的顺序执行项目，但被随机分配开始测试和开始肢体。我们通过平均试验得出每个肢体的综合评分，然后计算左右差异的绝对值，然后将此差异归一化为测试平均值，以获得百分比左右差异（％STS）。进行多元线性回归分析，以评估年龄对肢体对称性的影响，同时校正BMI，PMOS和性别。结果：％STS对于任何PPT均未呈正态分布，因此数据报告为中位数和四分位间距。所有PPT均显示基线肢体不对称，没有一个符合我们对有效性的定义。最对称的PPT是顺时针象限跳跃测试（女性的％STS，中位数= 9.85，四分位数范围= 4.63 – 18.7;男性的％STS，中位数= 6.9，四分位数范围= 3.64 – 14.04）。 BOSU测试中的鹳平衡具有最大的肢体不对称性（女性的％STS，中位数为41.4，四分位数范围为10.1 – 71.3;男性的％STS，中位数为47.6，四分位数范围为18.2 – 66.7）。 PMOS与年龄密切相关（Pearson's = 0.83），并且被排除在预测变量之外。仅在鹳测试中，年龄是％STS的独立预测因子（B = -1.15，95％CI = -1.92至-0.38，p = 0.004），而年龄较大的受试者肢体不对称性较小。结论：健康儿童在APT重建后通常具有用于RTS决策的PPT基线肢体明显不对称。在这项研究中评估的PPT均未达到我们对临床有效性的定义。肢体对称性通常不受受试者年龄的影响。临床意义：鉴于这些结果，在这一人群中应谨慎使用肢体对称指数（LSI）。与年龄和性别特定规范相比，可以更好地评估功能恢复。图2. BOSU Stork测试肢的对称性

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