Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study.
Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study.
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DOI：
10.1136/bjsports-2016-096031
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发表时间：
2016-07
影响因子：
18.4
通讯作者：
Risberg MA
中科院分区：
文献类型：
--
作者：
Grindem H;Snyder-Mackler L;Moksnes H;Engebretsen L;Risberg MA
前十字韧带 (ACL) 重建后膝关节再损伤很常见，并且会增加骨关节炎的风险。指导该人群重返体育（RTS）决策的证据很少。评估 ACL 重建后膝关节再损伤与 1) 恢复 I 级运动、2) 恢复运动时间和 3) 恢复前膝关节功能之间的关系。 106 名参加旋转运动的患者参与了这项为期两年的前瞻性队列研究。每月记录运动参与和膝盖再受伤情况。膝关节功能通过膝关节结果调查——日常生活活动量表、功能总体评定量表以及股四头肌力量和跳跃测试对称性进行评估。通过 RTS 标准定义为所有测试得分 >90，未通过任何测试。恢复 I 级运动的患者再受伤率比未恢复的患者高 4.32 (p=0.048)。 RTS 每延迟一个月，再损伤率就会显着降低 51%，直至术后 9 个月，此后没有观察到风险进一步降低。未通过 RTS 标准的患者中，有 38.2% 再次受伤，而通过 RTS 标准的患者中，这一比例为 5.6%（HR：0.16，p=0.075）。返回前更对称的股四头肌力量显着降低了膝盖再次受伤的几率。 ACL 重建后恢复 I 级运动会导致两年内再受伤率增加 4 倍以上。手术后 9 个月或更晚恢复运动，并且恢复前股四头肌力量更加对称，可以大大降低再受伤率。
Knee reinjury after anterior cruciate ligament (ACL) reconstruction is common and increases the risk of osteoarthritis. There is sparse evidence to guide return to sport (RTS) decisions in this population. To assess the relationship between knee reinjury after ACL reconstruction and 1) return to level I sports, 2) timing of return to sports, and 3) knee function prior to return. 106 patients who participated in pivoting sports participated in this prospective two year cohort study. Sports participation and knee reinjury were recorded monthly. Knee function was assessed with the Knee Outcome Survey–Activities of Daily Living Scale, global rating scale of function, and quadriceps strength and hop test symmetry. Pass RTS criteria was defined as scores >90 on all tests, failure as failing any. Patients who returned to level I sports had 4.32 (p=0.048) higher reinjury rate than those who did not. The reinjury rate was significantly reduced by 51 % for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. 38.2 % of those who failed RTS criteria suffered reinjuries versus 5.6 % of those who passed (HR: 0.16, p=0.075). More symmetrical quadriceps strength prior to return significantly reduced the knee reinjury rate. Returning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. Return to sport 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduces the reinjury rate.