Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction,Sports Medicine

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Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction
Sports Medicine ( IF 9.3 ) Pub Date : 2022-08-24 , DOI: 10.1007/s40279-022-01747-3
Anna Cronström _{1,

2} , Eva Tengman ₁ , Charlotte K Häger ₁

Affiliation

Background

The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified.

Objective

The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR.

Methods

A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality.

Results

Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69–9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26–3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32–3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58–2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21–2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34–2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39–0.59), female sex (OR 0.88, 95% CI 0.79–0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69–0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62–0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture.

Conclusion

Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.

中文翻译：

重返体育：一项有风险的生意吗？ACL 重建后移植物破裂危险因素的系统评价和荟萃分析

背景

前交叉韧带重建（ACLR）后持续移植物破裂的风险很高。然而，尚未明确确定影响风险的因素。

客观的

本系统评价的目的是确定和量化 ACLR 后移植物破裂的危险因素。

方法

根据 PRISMA 指南进行了系统评价和荟萃分析 (PROSPERO CRD42020140129)。MEDLINE、CINAHL 和 EMBASE 的检索时间从最初到 2021 年 9 月。考虑了针对所有年龄段的男性/女性 ACLR 后移植物破裂危险因素的前瞻性和回顾性研究。使用随机效应模型（效应测量：比值比 [OR] 和 95% 置信区间 [CI]）进行荟萃分析。GRADE 工具用于评估证据质量。

结果

对 310 篇相关论文进行全文筛选后，最终纳入了 117 篇，每次荟萃分析涉及多达 133,000 人。原发性损伤时 Tegner 活动水平较高（≥ 7 vs < 7）（OR 3.91，95% CI 1.69–9.04），胫骨坡度（度）增加（OR 2.21，95% CI 1.26–3.86），返回的心理准备度较低运动（RTS）（OR 2.18，95% CI 1.32–3.61）、早期手术（< 12 个月 vs ≥ 12 个月）（OR 1.87，95% CI 1.58–2.22）、RTS（受伤前水平）（OR 1.87，95 % CI 1.21–2.91）和 ACL 损伤家族史（OR 1.76，95% CI 1.34–2.31）均与移植物破裂几率增加相关。年龄较大（OR 0.47，95% CI 0.39–0.59）、女性（OR 0.88，95% CI 0.79–0.98）、重建前自我报告的膝关节症状较少（OR 0.81，95% CI 0.69–0.95）以及伴随的软骨损伤（OR 0.70，95% CI 0.62-0.79）反而降低了几率。荟萃分析显示，体重指数、吸烟、关节松弛、RTS 时间、膝关节运动学、肌肉力量或跳跃表现与移植物破裂之间没有关联。