DETERMINANTS OF RETURN TO PLAY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

ABSTRACT Objective: To systematically review and meta-analyze the performance of return to play (RTP) and non-RTP patients in different assessment tools after anterior cruciate ligament reconstructions (ACLR). Methods: Out of 182 studies searched on PubMed, 11 presented RTP and non-RTP groups assessing the performance of young individuals, practitioners of different sports, with different tools. Results: There was higher limb symmetry (7.13% [95%CI 4.55; 9.70], p < 0.001), Tegner activity scale (2.41 [95%CI 0.18; 4.64], p = 0.03), functional scores such as International Knee Documentation Committee (x7.44 [95%CI 4.69; 10.19], p < 0.001), Knee Osteoarthritis Outcome score for quality of life (14.75 [95%CI 10.96; 18.54], p < 0.001) and for sports/recreation (11.86 [95%CI 8.87; 14.86], p < 0.001); and lower knee laxity (-0.25 mm [95%CI -0.36; -0.14], p < 0.001) in RTP compared to non-RTP patients following ACLR. Conclusion: We confirmed that these different tools can differentiate RTP for non-RTP patients, which may contribute to the physician’s decision about the ideal time for RTP. Level of Evidence III, Systematic review of Level III studies.

摘要 研究目的：系统回顾并荟萃分析前交叉韧带重建（Anterior Cruciate Ligament Reconstructions, ACLR）术后重返运动（Return to Play, RTP）患者与非重返运动患者在不同评估工具中的表现差异。研究方法：在PubMed数据库检索得到的182项研究中，最终纳入11项设置重返运动与非重返运动分组、针对年轻个体及不同运动项目从业者、采用多类评估工具的研究。研究结果：与非重返运动患者相比，前交叉韧带重建术后重返运动患者的肢体对称性更高（7.13% [95%CI 4.55; 9.70], p < 0.001）、Tegner活动量表（Tegner Activity Scale）评分更高（2.41 [95%CI 0.18; 4.64], p = 0.03），功能评分包括国际膝关节文献委员会（International Knee Documentation Committee）评分（7.44 [95%CI 4.69; 10.19], p < 0.001）、膝关节骨关节炎结局评分（Knee Osteoarthritis Outcome Score）的生活质量维度得分（14.75 [95%CI 10.96; 18.54], p < 0.001）及运动/娱乐维度得分（11.86 [95%CI 8.87; 14.86], p < 0.001）均更优，且膝关节松弛度更低（-0.25 mm [95%CI -0.36; -0.14], p < 0.001）。研究结论：本研究证实上述各类评估工具可有效区分前交叉韧带重建术后的重返运动与非重返运动患者，可为临床医师确定重返运动的最佳时机提供决策参考。证据级别：Ⅲ级证据，针对Ⅲ级研究的系统回顾。