Ardern, Br J Sports Med 2014 - 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
|
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
Ardern, Webster, et al.·Br J Sports Med·2014·1,373 citations·Meta-analysis
Ardern and colleagues updated their earlier systematic review to estimate how many patients return to sport after ACL reconstruction and which factors predicted return.
Systematic review and meta‑analysis of 69 studies with 7556 participants, adding a search covering April 2010 through November 2013 to the original review.
Methods
Design
Random‑effects meta‑analysis
Updating the authors' earlier review
Search
10 databases
Inception to November 2013
Included
69 articles
7556 participants
Population
ACL reconstruction
Mean age 25.8 years
66% men
Comparison
Returners vs non‑returners by physical function and contextual factors
Outcomes
Return to any sport
Return to preinjury level
Return to competitive sport
Key Findings
Pooled return rates were 81% to any sport, 65% to the preinjury level and 55% to competitive sport.
Hop test symmetry had only a small association with reaching the preinjury level (standardized mean difference 0.3, 95% CI 0.002 to 0.5).
Patients graded IKDC normal (category A) had higher odds of reaching their preinjury level than those graded B to D (OR 1.9, 95% CI 1.1 to 3.5, p = 0.04).
The authors judged the graft‑type differences very likely confounded by selection bias, since most studies did not randomize graft choice.
Pooling the 4 randomized trials (n = 288) showed no graft difference in preinjury‑level return (OR 1.02, 95% CI 0.7 to 1.5, p = 0.92).
Length of follow‑up did not change any of the 3 return‑to‑sport rates.
Board pearl
Lower fear of reinjury and greater psychological readiness were strongly associated with reaching the preinjury level (standardized mean difference at least 0.9), and unlike age, sex or elite status they may be modifiable.
Authors' conclusion
Returning to sport varied according to different physical functioning and contextual factors, which could warrant additional emphasis in postoperative rehabilitation programmes to maximise participation.
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
Ardern, Webster, et al.·Br J Sports Med·2014·1,373 citations·Meta-analysis
Ardern and colleagues updated their earlier systematic review to estimate how many patients return to sport after ACL reconstruction and which factors predicted return.
Systematic review and meta‑analysis of 69 studies with 7556 participants, adding a search covering April 2010 through November 2013 to the original review.
Methods
Design
Random‑effects meta‑analysis
Updating the authors' earlier review
Search
10 databases
Inception to November 2013
Included
69 articles
7556 participants
Population
ACL reconstruction
Mean age 25.8 years
66% men
Comparison
Returners vs non‑returners by physical function and contextual factors
Outcomes
Return to any sport
Return to preinjury level
Return to competitive sport
Key Findings
Pooled return rates were 81% to any sport, 65% to the preinjury level and 55% to competitive sport.
Hop test symmetry had only a small association with reaching the preinjury level (standardized mean difference 0.3, 95% CI 0.002 to 0.5).
Patients graded IKDC normal (category A) had higher odds of reaching their preinjury level than those graded B to D (OR 1.9, 95% CI 1.1 to 3.5, p = 0.04).
The authors judged the graft‑type differences very likely confounded by selection bias, since most studies did not randomize graft choice.
Pooling the 4 randomized trials (n = 288) showed no graft difference in preinjury‑level return (OR 1.02, 95% CI 0.7 to 1.5, p = 0.92).
Length of follow‑up did not change any of the 3 return‑to‑sport rates.
Board pearl
Lower fear of reinjury and greater psychological readiness were strongly associated with reaching the preinjury level (standardized mean difference at least 0.9), and unlike age, sex or elite status they may be modifiable.
Authors' conclusion
Returning to sport varied according to different physical functioning and contextual factors, which could warrant additional emphasis in postoperative rehabilitation programmes to maximise participation.