前交叉韌帶重建術后重返運動評估方法研究進展_《中國修復重建外科雜志》

作者：

施政良 ,  李彥林 , 余洋 , 王國梁 , 寧梓文 , 何任杰 , 唐文婷 , 王坤

昆明醫科大學第一附屬醫院運動醫學科（昆明 650032）;

關鍵詞：

前交叉韌帶重建重返運動評估方法

DOI：

10.7507/1002-1892.202301029

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的總結近年前交叉韌帶（anterior cruciate ligament，ACL）重建術后患者重返運動的評估方法，以期為臨床提供參考。方法于CNKI、萬方、PubMed、外文醫學信息資源檢索平臺（FMRS）數據庫，檢索與ACL重建術后重返運動評估指標相關文獻，檢索范圍 2010 年—2023年，最終納入66篇文獻進行綜述。從重返運動時間、客觀評估指標以及心理評估等方面進行總結分析。結果重返運動是ACL損傷患者和醫生共同的愿望，合理完善的重返運動評估方法不僅能幫助患者恢復至傷前運動水平，還能避免患者再次損傷。目前，臨床判斷患者能否重返運動的主要標準為時間，術后9個月重返運動可以降低再次損傷發生風險已基本達成共識。除時間外，還需要對患者下肢肌力、跳躍、平衡性等方面進行測試，以全面評估患者功能恢復程度，以及結合運動類型確定不同的重返運動時間。此外，研究表明部分患者因心理因素影響導致術后無法恢復至傷前運動水平，因此心理評估在重返運動中有著重要意義，需要在評估時完善相關項目。結論重返運動是ACL重建術后研究熱點之一，目前相關評估方法較多，有待更多研究進一步優化，以構建一個全面、標準化綜合評估體系。

引用本文： 施政良, 李彥林, 余洋, 王國梁, 寧梓文, 何任杰, 唐文婷, 王坤. 前交叉韌帶重建術后重返運動評估方法研究進展. 中國修復重建外科雜志, 2023, 37(4): 495-501. doi: 10.7507/1002-1892.202301029 復制

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1. Ardern CL, Taylor NF, Feller JA, et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med, 2014, 48(21): 1543-1552.
2. Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med, 2011, 45(7): 596-606.
3. Ohji S, Aizawa J, Hirohata K, et al. The gap between subjective return to sports and subjective athletic performance intensity after anterior cruciate ligament reconstruction. Orthop J Sports Med, 2020, 8(9): 2325967120947402. doi: 10.1177/2325967120947402.
4. Roe C, Jacobs C, Hoch J, et al. Test batteries after primary anterior cruciate ligament reconstruction: A systematic review. Sports Health, 2022, 14(2): 205-215.
5. Ardern CL, Glasgow P, Schneiders AG, et al. Infographic: 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med, 2017, 51(13): 995. doi: 10.1136/bjsports-2016-097468.
6. Dingenen B, Gokeler A. Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: A critical step back to move forward. Sports Med, 2017, 47(8): 1487-1500.
7. Burgi CR, Peters S, Ardern CL, et al. Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review. Br J Sports Med, 2019, 53(18): 1154-1161.
8. Webster KE, Feller JA. Who passes return-to-sport tests, and which tests are most strongly associated with return to play after anterior cruciate ligament reconstruction? Orthop J Sports Med, 2020, 8(12): 2325967120969425. doi: 10.1177/2325967120969425.
9. Zhu W, Wang D, Han Y, et al. Anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons: clinical research among three rehabilitation procedures. Eur J Orthop Surg Traumatol, 2013, 23(8): 939-943.
10. 楊濤, 周敬濱, 陳天午, 等. 優秀運動員前交叉韌帶重建后何時重返運動: 一項基于等速肌力和多種單腳跳測試的研究. 中國運動醫學雜志, 2018, 37(3): 185-191.
11. Turk R, Shah S, Chilton M, et al. Return to sport after anterior cruciate ligament reconstruction requires evaluation of >2 functional tests, psychological readiness, quadriceps/hamstring strength, and time after surgery of 8 months. Arthroscopy, 2023, 39(3): 790-801.
12. Kitaguchi T, Tanaka Y, Takeshita S, et al. Preoperative quadriceps strength as a predictor of return to sports after anterior cruciate ligament reconstruction in competitive athletes. Phys Ther Sport, 2020, 45: 7-13.
13. Buckthorpe M, Della Villa F. Optimising the ‘mid-stage’ training and testing process after ACL reconstruction. Sports Med, 2020, 50(4): 657-678.
14. Török L, Jávor P, Török K, et al. Early return to play after anterior cruciate ligament reconstruction: Is it worth the risk? Ann Rehabil Med, 2022, 46(2): 97-107.
15. Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: A prospective comparative study of 502 patients from the SANTI Study Group. Am J Sports Med, 2017, 45(7): 1547-1557.
16. Meredith SJ, Rauer T, Chmielewski TL, et al. Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. J ISAKOS, 2021, 6(3): 138-146.
17. Werner JL, Burland JP, Mattacola CG, et al. Decision to return to sport participation after anterior cruciate ligament reconstruction, Part Ⅱ: Self-reported and functional performance outcomes. J Athl Train, 2018, 53(5): 464-474.
18. Ebert JR, Edwards P, Yi L, et al. Strength and functional symmetry is associated with post-operative rehabilitation in patients following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2018, 26(8): 2353-2361.
19. Maestroni L, Papadopoulos K, Turner A, et al. Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction. Phys Ther Sport, 2021, 48: 209-218.
20. Kyritsis P, Bahr R, Landreau P, et al. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med, 2016, 50(15): 946-951.
21. van der Horst N, Denderen RV. Isokinetic hamstring and quadriceps strength interpretation guideline for football (soccer) players with ACL reconstruction: a Delphi consensus study in the Netherlands. Sci Med Footb, 2022, 6(4): 434-445.
22. Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, et al. Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc, 2011, 19(3): 390-397.
23. van Melick N, Pronk Y, Nijhuis-van der Sanden M, et al. Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate. J Orthop Res, 2022, 40(1): 117-128.
24. Ohji S, Aizawa J, Hirohata K, et al. Single-leg hop distance normalized to body height is associated with the return to sports after anterior cruciate ligament reconstruction. J Exp Orthop, 2021, 8(1): 26. doi: 10.1186/s40634-021-00344-z.
25. Nawasreh Z, Logerstedt D, Cummer K, et al. Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med, 2018, 52(6): 375. doi: 10.1136/bjsports-2016-097095.
26. Willigenburg N, Hewett TE. Performance on the functional movement screen is related to hop performance but not to hip and knee strength in collegiate football players. Clin J Sport Med, 2017, 27(2): 119-126.
27. Sousa PL, Krych AJ, Cates RA, et al. Return to sport: Does excellent 6-month strength and function following ACL reconstruction predict midterm outcomes? Knee Surg Sports Traumatol Arthrosc, 2017, 25(5): 1356-1363.
28. Niederer D, Giesche F, Janko M, et al. Unanticipated jump-landing quality in patients with anterior cruciate ligament reconstruction: How long after the surgery and return to sport does the re-injury risk factor persist? Clin Biomech (Bristol, Avon), 2020, 72: 195-201.
29. Ohji S, Aizawa J, Hirohata K, et al. Characteristics of landing impact in athletes who have not returned to sports at the pre-injury competition level after anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2021, 25: 47-52.
30. Oleksy ?, Mika A, Sulowska-Daszyk I, et al. Standard RTS criteria effectiveness verification using FMS, Y-balance and TJA in footballers following ACL reconstruction and mild lower limb injuries. Sci Rep, 2021, 11(1): 1558. doi: 10.1038/s41598-021-81152-4.
31. Kotsifaki A, Van Rossom S, Whiteley R, et al. Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. Br J Sports Med, 2022, 56(9): 490-498.
32. Read P, Mc Auliffe S, Wilson MG, et al. Better reporting standards are needed to enhance the quality of hop testing in the setting of ACL return to sport decisions: a narrative review. Br J Sports Med, 2021, 55(1): 23-29.
33. DiFabio M, Slater LV, Norte G, et al. Relationships of functional tests following ACL reconstruction: Exploratory factor analyses of the lower extremity assessment protocol. J Sport Rehabil, 2018, 27(2): 144-150.
34. Schmitt LC, Brunst C, Ithurburn M, et al. Identification and predictors of age-relevant and activity-relevant hop test targets in young athletes after anterior cruciate ligament reconstruction. J Athl Train, 2022, 57(9-10): 946-954.
35. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train, 2012, 47(3): 339-357.
36. Gribble PA, Kelly SE, Refshauge KM, et al. Interrater reliability of the star excursion balance test. J Athl Train, 2013, 48(5): 621-626.
37. Collings TJ, Bourne MN, Barrett RS, et al. Risk factors for lower limb injury in female team field and court sports: a systematic review, meta-analysis, and best evidence synthesis. Sports Med, 2021, 51(4): 759-776.
38. Garrison JC, Bothwell JM, Wolf G, et al. Y Balance Test^TM anterior reach symmetry at three months is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction. Int J Sports Phys Ther, 2015, 10(5): 602-611.
39. Saper M, Wong C, Strauss N. Adolescent patients exhibit significant improvements in strength and functional performance from 6 to 9 months after acl reconstruction with quadriceps autograft. Arthrosc Sports Med Rehabil, 2021, 3(3): e837-e843.
40. Della Villa F, Andriolo L, Ricci M, et al. Compliance in post-operative rehabilitation is a key factor for return to sport after revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 463-469.
41. Besier TF, Lloyd DG, Ackland TR, et al. Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc, 2001, 33(7): 1176-1181.
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《中國修復重建外科雜志》

前交叉韌帶重建術后重返運動評估方法研究進展

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《中國修復重建外科雜志》

前交叉韌帶重建術后重返運動評估方法研究進展

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