Rückkehr zum Sport nach Rekonstruktion des vorderen Kreuzbandes – Welche Faktoren beeinflussen die Return to Sport-Entscheidung?

Zusammenfassung

Hintergrund Es ist unklar, welche validen Kriterien herangezogen werden sollen, um eine Freigabe zum Sport (Return to Sport, RTS) nach Rekonstruktion des vorderen Kreuzbandes (VKBR) zu begründen. Die Fragestellung ist, ob das Geschlecht, das Alter, das Outcome der isokinetischen Maximalkraftmessung und des Einbein-Sprungtests (quantitativ/qualitativ) Einfluss auf die Entscheidung für eine Rückkehr zum Sport 9 Monate nach VKBR haben.

Methoden Die vorliegende Studie ist eine retrospektiven Datenanalyse. Die Fragestellung wurde anhand einer multiplen logistischen Regressionsanalyse (MLR) beantwortet. Die abhängige Variable „RTS ja/nein“ basiert auf der Entscheidung des behandelnden Orthopäden 9 Monate (±30 Tage) nach VKBR unter Berücksichtigung der Funktionstests. Der Einfluss folgender Faktoren wurde geprüft: Geschlecht, Alter, Limb Symmetry Index (LSI) der Maximalkrafttests der Knieextensoren und -flexoren bei 60°/s, LSI des Einbein-Sprungtests und die Beurteilung der funktionellen Beinachse bezüglich der Knievalgusstellung zum Zeitpunkt der RTS-Entscheidung.

Resultate 71 Patientendaten wurden in die MLR eingeschlossen. Die Odds Ratio (OR) für eine Sportfreigabe wurde erhöht durch das weibliche Geschlecht (OR 4,808; p=0,035), höhere Werte des LSI der maximalen Knieextensionskraft (OR 1,117; p=0,009) und höhere Werte des LSI des Einbein-Sprungtests (OR 1,125; p=0,020). Das Alter, der LSI der Maximalkraft der Knieflexion und die funktionelle Beinachse (Valgus) hatten keinen Einfluss auf die RTS-Entscheidung.

Schlussfolgerung Das Geschlecht sowie die LSI-Werte der Maximalkraft der Knieextensoren und des Einbein-Sprungtests stehen in Zusammenhang mit RTS nach 9 Monaten. Die Resultate sollen zur Optimierung der Rehabilitation nach VKBR in Betracht gezogen werden. In Zukunft sollten das präoperative Aktivitätslevel und die psychologische Bereitschaft, um in den Sport zurückzukehren, erhoben werden, um dessen Einfluss auf die RTS-Entscheidung überprüfen zu können.

Abstract

Background It is unknown which valid criteria should be considered to justify the decision for return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The research question is whether gender, age, the outcome of the isokinetic maximal strength measurement and the single-leg hop test (quantitative/qualitative) influence the decision for RTS nine months after ACLR.

Methods This study is a retrospective data analysis. The research question was evaluated with a multiple logistic regression analysis (MLR). The dependent variable, RTS yes/no, is based on the decision of the orthopaedist in charge of treatment nine months (±30 days) after ACLR. The following possible influencing factors were investigated: gender, age, limb symmetry index (LSI) of maximal knee extension and knee flexion strength at 60°/sec., LSI of single-leg hop test and evaluation of knee valgus.

Results Data of 71 patients were included for MLR. The odds ratios (OR) for RTS increased with female gender (OR, 4.808; p=0.035), a higher LSI of maximal strength of knee extension (OR, 1.117; p=0.009) and a higher LSI of the single-leg hop test (OR, 1.125; p=0.020). Age, the LSI of maximal strength of knee flexion and knee valgus had no influence on the RTS decision.

Conclusion Gender and the limb symmetry indexes of the maximal strength of knee extension and of the single-leg hop test are associated with RTS nine months after ACLR. These results should be considered to optimise rehabilitation after ACLR.

Schlüsselwörter

VKB-Rekonstruktion - Rückkehr zum Sport - Rehabilitation - Entscheidungsprozess

Keywords

anterior cruciate ligament reconstruction - return to sport - rehabilitation - decision-making

Publication History

Received: 04 August 2022

Accepted after revision: 01 February 2023

Article published online:
22 June 2023

• Literatur

• 1 Grindem H, Snyder-Mackler L, Moksnes H. et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. British journal of sports medicine 2016; 50: 804-808 DOI: 10.1136/bjsports-2016-096031. (PMID: 27162233)
• 2 Nawasreh Z, Adams G, Pryzbylkowski O. et al. Influence of Patient Demographics and Graft Types on ACL Second Injury Rates in Ipsilateral Versus Contralateral Knees: A Systematic Review and Meta-Analysis. International journal of sports physical therapy 2018; 13: 561-574 (PMID: 30140550)
• 3 Ardern CL. Anterior Cruciate Ligament Reconstruction-Not Exactly a One-Way Ticket Back to the Preinjury Level: A Review of Contextual Factors Affecting Return to Sport After Surgery. Sports health 2015; 7: 224-230 DOI: 10.1177/1941738115578131. (PMID: 26131299)
• 4 Kotsifaki A, Whiteley R, Van Rossom S. et al. Single leg hop for distance symmetry masks lower limb biomechanics: time to discuss hop distance as decision criterion for return to sport after ACL reconstruction?. British journal of sports medicine 2022; 56: 249-256 DOI: 10.1136/bjsports-2020-103677. (PMID: 33687928)
• 5 Andrade R, Pereira R, van Cingel R. et al. How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE II). British journal of sports medicine 2020; 54: 512-519 DOI: 10.1136/bjsports-2018-100310.
• 6 Bodkin SG, Hertel J, Diduch DR. et al. Predicting Anterior Cruciate Ligament Reinjury From Return-to-Activity Assessments at 6 Months Postsurgery: A Prospective Cohort Study. Journal of athletic training 2022; 57: 325-333 DOI: 10.4085/1062-6050-0407.20.
• 7 Ebert JR, Edwards P, Currie J. et al. Comparison of the ‘Back in Action’ Test Battery to Standard Hop Tests and Isokinetic Knee Dynamometry in Patients Following Anterior Cruciate Ligament Reconstruction. International journal of sports physical therapy 2018; 13: 389-400 (PMID: 30038825)
• 8 Welling W, Benjaminse A, Seil R. et al. Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2018; 26: 3636-3644 DOI: 10.1007/s00167-018-4916-4.
• 9 Cristiani R, Mikkelsen C, Forssblad M. et al. Only one patient out of five achieves symmetrical knee function 6 months after primary anterior cruciate ligament reconstruction. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2019; DOI: 10.1007/s00167-019-05396-4.
• 10 Anderson MJ, Browning 3rd WM, Urband CE. et al. A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament. Orthopaedic journal of sports medicine 2016; 4: 2325967116634074 DOI: 10.1177/2325967116634074. (PMID: 27047983)
• 11 Ellman MB, Sherman SL, Forsythe B. et al. Return to play following anterior cruciate ligament reconstruction. JAAOS-Journal of the American Academy of Orthopaedic Surgeons 2015; 23: 283-296 DOI: 10.5435/JAAOS-D-13-00183. (PMID: 25911661)
• 12 Petersen W, Zantop T. Return to play following ACL reconstruction: survey among experienced arthroscopic surgeons (AGA instructors). Archives of orthopaedic and trauma surgery 2013; 133: 969-977 DOI: 10.1007/s00402-013-1746-1. (PMID: 23604790)
• 13 Field A. Discovering statistics using IBM SPSS statistics. 5. Aufl. Los Angeles: SAGE; 2018
• 14 Devana SK, Solorzano C, Nwachukwu B. et al. Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes. Current reviews in musculoskeletal medicine 2022; 15: 1-9 DOI: 10.1007/s12178-021-09736-1. (PMID: 34970713)
• 15 Ardern CL, Webster KE, Taylor NF. et al. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. The American journal of sports medicine 2011; 39: 538-543
• 16 Rodriguez-Roiz JM, Caballero M, Ares O. et al. Return to recreational sports activity after anterior cruciate ligament reconstruction: a one- to six-year follow-up study. Archives of orthopaedic and trauma surgery 2015; 135: 1117-1122 DOI: 10.1007/s00402-015-2240-8. (PMID: 25997812)
• 17 Webster KE, Nagelli CV, Hewett TE. et al. Factors Associated With Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. The American journal of sports medicine 2018; 46: 1545-1550 DOI: 10.1177/0363546518773757.
• 18 Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. The Journal of orthopaedic and sports physical therapy 2017; 47: 334-338 DOI: 10.2519/jospt.2017.7285. (PMID: 28355978)
• 19 Petersen W, Taheri P, Forkel P. et al. Return to play following ACL reconstruction: a systematic review about strength deficits. Archives of orthopaedic and trauma surgery 2014; 134: 1417-1428 DOI: 10.1007/s00402-014-1992-x.
• 20 Ardern CL, Osterberg A, Tagesson S. et al. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. British journal of sports medicine 2014; 48: 1613-1619 DOI: 10.1136/bjsports-2014-093842. (PMID: 25293342)
• 21 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. British journal of sports medicine 2014; 48: 1543-1552 DOI: 10.1136/bjsports-2013-093398. (PMID: 25157180)
• 22 Webster KE, Feller JA, Kimp AJ. et al. Revision Anterior Cruciate Ligament Reconstruction Outcomes in Younger Patients: Medial Meniscal Pathology and High Rates of Return to Sport Are Associated With Third ACL Injuries. The American journal of sports medicine 2018; 46: 1137-1142 DOI: 10.1177/0363546517751141.
• 23 Kaplan Y, Witvrouw E. When Is It Safe to Return to Sport After ACL Reconstruction? Reviewing the Criteria. Sports health 2019; 11: 301-305 DOI: 10.1177/1941738119846502. (PMID: 31136725)
• 24 Gagnon SS, Birmingham TB, Chesworth BM. et al. Development of a Clinician-Rated Drop Vertical Jump Scale for Patients Undergoing Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Delphi Approach. The Journal of orthopaedic and sports physical therapy 2017; 47: 557-564 DOI: 10.2519/jospt.2017.7183. (PMID: 28683233)
• 25 Ardern CL, Glasgow P, Schneiders A. et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British journal of sports medicine 2016; 50: 853-864 DOI: 10.1136/bjsports-2016-096278.