Background:

Although objective outcomes assessing knee function are essential measurements for return to sport, psychological factors have become increasingly recognized as equally important parameters for determining an athlete’s ability to return to sport after surgery.

Purpose:

To systematically review the literature to determine whether patients who returned to sport after anterior cruciate ligament (ACL) reconstruction had improved psychological scores (as measured with validated questionnaires) compared with patients who did not return to sport.

Study Design:

Systematic review and meta-analysis; Level of evidence, 3.

Methods:

A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was preregistered on PROSPERO. Four databases were searched for level 1 to 3 studies that compared at least 1 psychological outcome measured by a validated questionnaire for patients who did and did not return to sport after primary ACL reconstruction. The following data were recorded: study and patient characteristics; psychological metrics (ACL–Return to Sport Injury [ACL-RSI] scale, Knee Self-Efficacy Scale [K-SES], and Tampa Scale of Kinesiophobia [TSK/TSK-11]); International Knee Documentation Committee (IKDC) score; and clinical metrics. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS), and the mean difference (MD) and 95% CI were calculated for each psychological outcome score using the inverse variance method.

Results:

We included and analyzed 16 articles (3744 patients; 38.9% female; mean age range, 17-28.7 years; mean MINORS score, 19.9 ± 1.4). Overall, 61.8% of athletes returned to sport (66.8% of male patients; 55.4% of female patients). Patients who returned scored significantly higher on the ACL-RSI scale (MD, 20.8; 95% CI, 15.9 to 25.7; P < .001), significantly higher on the K-SES (MD, 1.3; 95% CI, 0.2 to 2.3; P = .036), and significantly lower on the TSK/TSK-11 (MD, 10.1%; 95% CI, −12.1% to −8.2%; P = .004). Those returning to sport did not exceed the minimal clinically important difference for IKDC score versus those not returning to sport.

Conclusion:

Patients who returned to sport after primary ACL reconstruction had significantly higher psychological readiness, higher self-efficacy, and lower kinesiophobia compared with those who did not return to sport, despite having clinically similar knee function scores. Evaluation of psychological readiness, in combination with other objective measurements, is a critical component of return-to-sport evaluation in athletes after primary ACL reconstruction.

Registration:

CRD42021284735 (PROSPERO).

中文翻译：

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原发性前十字韧带重建后恢复运动的患者心理准备度显着提高：对 3744 名患者的系统回顾和荟萃分析

背景：

尽管评估膝关节功能的客观结果是恢复运动的重要衡量标准，但心理因素已越来越被认为是确定运动员术后恢复运动能力的同等重要参数。

目的：

系统地回顾文献，以确定与未恢复运动的患者相比，前十字韧带（ACL）重建后恢复运动的患者心理评分（通过经过验证的问卷测量）是否有所改善。

学习规划：

系统回顾和荟萃分析；证据级别，3。

方法：

使用 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行了系统评价，并在 PROSPERO 上进行了预注册。搜索了四个数据库进行 1 至 3 级研究，这些研究比较了通过验证问卷测量的至少 1 项心理结果，这些患者在初次 ACL 重建后恢复和未恢复运动。记录以下数据：研究和患者特征；心理指标（ACL-恢复运动损伤 [ACL-RSI] 量表、膝关节自我效能量表 [K-SES] 和坦帕运动恐惧量表 [TSK/TSK-11]）；国际膝关节文献委员会（IKDC）评分；和临床指标。使用非随机研究方法学指数（MINORS）分析研究方法学质量，并使用逆方差法计算每个心理结果评分的均数差（MD）和95％CI。

结果：

我们纳入并分析了 16 篇文章（3744 名患者；38.9% 为女性；平均年龄范围，17-28.7 岁；平均未成年人评分，19.9 ± 1.4）。总体而言，61.8% 的运动员重返运动（男性患者为 66.8%；女性患者为 55.4%）。返回的患者在 ACL-RSI 量表上的得分显着更高（MD，20.8；95% CI，15.9 至 25.7；P < .001），在 K-SES 上的得分显着更高（MD，1.3；95% CI，0.2 至 2.3） ；P = .036），并且在 TSK/TSK-11 上显着较低（MD，10.1%；95% CI，-12.1% 至 -8.2%；P = .004）。那些重返运动的人与那些没有重返运动的人相比，IKDC 评分没有超过最小的临床重要差异。

结论：

尽管膝关节功能评分在临床上相似，但与未恢复运动的患者相比，初次 ACL 重建后恢复运动的患者具有显着更高的心理准备度、更高的自我效能和更低的运动恐惧症。心理准备度评估与其他客观测量相结合，是初级 ACL 重建后运动员重返运动评估的重要组成部分。

登记：

CRD42021284735（普洛斯彼罗）。