Effectiveness of Conservative Interventions After Acute Hamstrings Injuries in Athletes: A Living Systematic Review,Sports Medicine

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Effectiveness of Conservative Interventions After Acute Hamstrings Injuries in Athletes: A Living Systematic Review
Sports Medicine ( IF 9.3 ) Pub Date : 2023-01-09 , DOI: 10.1007/s40279-022-01783-z
José Afonso ₁ , Jesús Olivares-Jabalera _{2,

3} , Ricardo J Fernandes _{1,

4} , Filipe Manuel Clemente _{5,

6} , Sílvia Rocha-Rodrigues _{5,

7,

8} , João Gustavo Claudino _{9,

10} , Rodrigo Ramirez-Campillo ₁₁ , Cristina Valente _{12,

13} , Renato Andrade _{4,

12,

13} , João Espregueira-Mendes _{12,

13,

14,

15,

16}

Affiliation

Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal.
Sport Research Lab, Football Science Institute, Granada, Spain.
Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.
Porto Biomechanics Laboratory (LABIOMEP), University of Porto, Porto, Portugal.
Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal.
Delegação da Covilhã, Instituto de Telecomunicações, Covilhã, Portugal.
Tumor & Microenvironment Interactions Group, INEB-Institute of Biomedical Engineering, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
Research Center in Sports Performance, Recreation, Innovation and Technology (SPRINT), Melgaço, Portugal.
Group of Research, Innovation and Technology Applied to Sport (GSporTech), Multi-user Laboratory of the Department of Physical Education (MultiLab of the DPE), Department of Physical Education, Center for Health Sciences, Federal University of Piauí, Teresina, Piauí, Brazil.
Department of Physical Education, Center for Health Sciences, Federal University of Piauí, Teresina, Piauí, Brazil.
Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile.
Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal.
Dom Henrique Research Centre, Porto, Portugal.
School of Medicine, University of Minho, Braga, Portugal.
ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
3B's Research Group Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805 017, Guimarães, Portugal.

Background

Hamstrings injuries are common in sports and the reinjury risk is high. Despite the extensive literature on hamstrings injuries, the effectiveness of the different conservative (i.e., non-surgical) interventions (i.e., modalities and doses) for the rehabilitation of athletes with acute hamstrings injuries is unclear.

Objective

We aimed to compare the effects of different conservative interventions in time to return to sport (TRTS) and/or time to return to full training (TRFT) and reinjury-related outcomes after acute hamstrings injuries in athletes.

Data Sources

We searched CINAHL, Cochrane Library, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science databases up to 1 January, 2022, complemented with manual searches, prospective citation tracking, and consultation of external experts.

Eligibility Criteria

The eligibility criteria were multi-arm studies (randomized and non-randomized) that compared conservative treatments of acute hamstrings injuries in athletes.

Data Analysis

We summarized the characteristics of included studies and conservative interventions and analyzed data for main outcomes (TRTS, TRFT, and rate of reinjuries). The risk of bias was judged using the Cochrane tools. Quality and completeness of reporting of therapeutic exercise programs were appraised with the i-CONTENT tool and the certainty of evidence was judged using the GRADE framework. TRTS and TRFT were analyzed using mean differences and the risk of reinjury with relative risks.

Results

Fourteen studies (12 randomized and two non-randomized) comprising 730 athletes (mostly men with ages between 14 and 49 years) from different sports were included. Nine randomized studies were judged at high risk and three at low risk of bias, and the two non-randomized studies were judged at critical risk of bias. Seven randomized studies compared exercise-based interventions (e.g., L-protocol vs C-protocol), one randomized study compared the use of low-level laser therapy, and three randomized and two non-randomized studies compared injections of platelet-rich plasma to placebo or no injection. These low-level laser therapy and platelet-rich plasma studies complemented their interventions with an exercise program. Only three studies were judged at low overall risk of ineffectiveness (i-CONTENT). No single intervention or combination of interventions proved superior in achieving a faster TRTS/TRFT or reducing the risk of reinjury. Only eccentric lengthening exercises showed limited evidence in allowing a shorter TRFT. The platelet-rich plasma treatment did not consistently reduce the TRFT or have any effect on the risk of new hamstrings injuries. The certainty of evidence was very low for all outcomes and comparisons.

Conclusions

Available evidence precludes the prioritization of a particular exercise-based intervention for athletes with acute hamstrings injuries, as different exercise-based interventions showed comparable effects on TRTS/TRFT and the risk of reinjuries. Available evidence also does not support the use of platelet-rich plasma or low-level laser therapy in clinical practice. The currently available literature is limited because of the risk of bias, risk of ineffectiveness of exercise protocols (as assessed with the i-CONTENT), and the lack of comparability across existing studies.

Clinical Trial Registration

PROSPERO CRD42021268499 and OSF (https://osf.io/3k4u2/).

中文翻译：

运动员急性腿筋损伤后保守干预的有效性：实时系统评价

背景

腿筋损伤在运动中很常见，再次受伤的风险很高。尽管有大量关于腘绳肌损伤的文献，但不同的保守（即非手术）干预（即方式和剂量）对急性腘绳肌损伤运动员康复的有效性尚不清楚。

客观的

我们的目的是比较不同保守干预对运动员急性腘绳肌损伤后恢复运动时间 (TRTS) 和/或恢复全面训练时间 (TRFT) 和再损伤相关结果的影响。

数据源

我们检索了截至 2022 年 1 月 1 日的 CINAHL、Cochrane Library、EMBASE、PubMed、Scopus、SPORTDiscus 和 Web of Science 数据库，并辅以手动检索、前瞻性引文跟踪和外部专家咨询。

资格标准

资格标准是比较运动员急性腿筋损伤的保守治疗的多臂研究（随机和非随机）。

数据分析

我们总结了纳入研究和保守干预的特征，并分析了主要结果（TRTS、TRFT 和再损伤率）的数据。使用 Cochrane 工具判断偏倚风险。使用 i-CONTENT 工具评估治疗性锻炼计划报告的质量和完整性，并使用 GRADE 框架判断证据的确定性。TRTS 和 TRFT 使用平均差和再损伤风险与相对风险进行分析。

结果

纳入了 14 项研究（12 项随机研究和两项非随机研究），包括来自不同运动项目的 730 名运动员（大多数年龄在 14 至 49 岁之间的男性）。9 项随机研究被判定为高偏倚风险，3 项随机研究被判定为低偏倚风险，2 项非随机研究被判定为严重偏倚风险。七项随机研究比较了基于运动的干预措施（例如，L 协议与 C 协议），一项随机研究比较了低强度激光疗法的使用，三项随机研究和两项非随机研究比较了注射富含血小板的血浆与安慰剂或不注射。这些低强度激光疗法和富含血小板的血浆研究通过锻炼计划补充了他们的干预措施。只有三项研究被判定为低总体无效风险 (i-CONTENT)。在实现更快的 TRTS/TRFT 或降低再次受伤的风险方面，没有任何一种干预或干预组合被证明具有优势。只有偏心拉长练习显示允许更短的 TRFT 的证据有限。富含血小板的血浆治疗并没有始终如一地降低 TRFT 或对新腿筋受伤的风险有任何影响。所有结果和比较的证据质量都非常低。

结论

现有证据排除了对急性腿筋损伤运动员进行特定运动干预的优先顺序，因为不同的运动干预对 TRTS/TRFT 和再次受伤的风险显示出相当的效果。现有证据也不支持在临床实践中使用富含血小板的血浆或低强度激光治疗。由于存在偏倚风险、运动方案无效的风险（使用 i-CONTENT 评估）以及现有研究之间缺乏可比性，目前可用的文献有限。

临床试验注册

PROSPERO CRD42021268499 和 OSF (https://osf.io/3k4u2/)。

更新日期：2023-01-10

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