Retorno al deporte en pacientes con cirugía primaria, revisión y re-revisión del ligamento cruzado anterior: estudio de cohorte comparativo con seguimiento mínimo de seis años
DOI:
https://doi.org/10.63403/re.v32i2.403Palabras clave:
Retorno al Deporte, Revisión LCA, Re-revisión LCA, Desempeño DeportivoResumen
Introducción: el retorno al deporte luego de las reconstrucciones del ligamento cruzado anterior es un proceso multifactorial.
Objetivos: comparar comparar retrospectivamente los resultados deportivos en una serie consecutiva de pacientes con cirugías primarias de LCA, revisión de LCA (RLCA) y re - revisión de LCA (R-RLCA) con un seguimiento mínimo de seis años.
Materiales y métodos: se evaluaron ciento treinta y cinco pacientes divididos en tres grupos. Se registraron el tipo de actividad deportiva, el impacto, frecuencia, motivación, expectativas, tiempo de retorno al deporte, las fallas y escalas (Lysholm, IKDC y Tegner).
Resultados: grupo A (reconstrucción primaria) incluyó ochenta y dos pacientes con una mediana de edad de veinte años (RIC: 25-45) y un seguimiento de ciento treinta y seis meses (RIC: 106-150). El tiempo promedio de retorno al deporte fue de once meses (DE: 1.4). Un 53 % retornó a un nivel superior, 37 % a niveles inferiores y 7 % no retornaron. La puntuación de Tegner se mantuvo estable en 7 (RIC: 5-7).
El grupo B (revisiones) comprendió a cuarenta y un pacientes, la mediana de edad en el momento de la revisión fue de veintinueve años (RIC: 24-36) y un seguimiento de setenta y tres meses (RIC: 58-81). El tiempo promedio de retorno fue de 12.5 meses. Un 73 % retornó al mismo nivel, 21 % a niveles inferiores y 6 % no retornó. Tegner disminuyó de 7 (RIC: 7-7) a 4 (RIC: 4-7).
En el grupo C (re-revisiones), con doce pacientes, la mediana de edad fue de treinta y dos años (RIC: 30-34 años) y un seguimiento de sesenta y un meses (RIC: 28-108). El tiempo promedio de retorno fue de doce meses. Un 42 % no retornó, 42 % lo hizo a un nivel inferior y 16 % al mismo nivel. Tegner disminuyó de 7 (RIC: 7-7) a 5 (RIC: 4-7).
Independientemente de la edad, el número de cirugías es un factor asociado a no retornar al deporte [OR: 0.2 (IC 95 % 0.05, 0.85; p <0.03)].
Conclusión: las cirugías repetidas de reconstrucción del LCA se asocian con una reducción en la participación en deportes de alto impacto y un incremento en la asistencia de los de impacto moderado, independientemente de la edad al momento de la cirugía.
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Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ, et al. Consensus criteria for defining “successful outcome” after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med. 2015 Mar;49(5):335–342. doi: https://www.doi.org/10.1136/bjsports-2013-092299. DOI: https://doi.org/10.1136/bjsports-2013-092299
Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016 Jul;50(14):853–864. doi: https://www.doi.org/10.1136/bjsports-2016-096278. DOI: https://doi.org/10.1136/bjsports-2016-096278
Flagg KY, Karavatas SG, Thompson S Jr, Bennett C. Current criteria for return to play after anterior cruciate ligament reconstruction: an evidence-based literature review. Ann Transl Med. 2019 Oct;7(Suppl 7):S252. doi: https://www.doi.org/10.21037/atm.2019.08.23. DOI: https://doi.org/10.21037/atm.2019.08.23
Ardern CL, Österberg A, Tagesson S, Gauffin H, Webster KE, Kvist J. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014 Dec;48(22):1613-1619. doi: https://www.doi.org/10.1136/bjsports-2014-093842.
Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2012 Jan;40(1):41-48. doi: https://www.doi.org/10.1177/0363546511422999. DOI: https://doi.org/10.1177/0363546511422999
Brophy RH, Schmitz L, Wright RW, Dunn WR, Parker RD, Andrish JT, et al. Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group. Am J Sports Med. 2012 Nov;40(11):2517-2522. doi: https://www.doi.org/10.1177/0363546512459476. DOI: https://doi.org/10.1177/0363546512459476
Erickson BJ, Harris JD, Cvetanovich GL, Bach BR, Bush-Joseph CA, Abrams GD, et al. Performance and return to sport after anterior cruciate ligament reconstruction in male Major League Soccer Players. Orthop J Sports Med. 2013 Jul;1(2):2325967113497189. doi: https://www.doi.org/10.1177/2325967113497189. DOI: https://doi.org/10.1177/2325967113497189
Grassi A, Zaffagnini S, Marcheggiani Muccioli GM, Neri MP, Della Villa S, Marcacci M. After revision anterior cruciate ligament reconstruction, who returns to sport? a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(20):1295–1304. doi: https://www.doi.org/10.1136/bjsports-2014-094089. DOI: https://doi.org/10.1136/bjsports-2014-094089
Battaglia MJ 2nd, Cordasco FA, Hannafin JA, Rodeo SA, O’Brien SJ, Altchek DW, et al. Results of revision anterior cruciate ligament surgery. Am J Sports Med. 2007 Dec;35(12):2057–2066. doi: https://www.doi.org/10.1177/0363546507307391. DOI: https://doi.org/10.1177/0363546507307391
Diamantopoulos AP, Lorbach O, Paessler HH. Anterior cruciate ligament revision reconstruction: results in 107 patients. Am J Sports Med. 2008 May;36(5):851–860. doi: https://www.doi.org/10.1177/0363546507312381. DOI: https://doi.org/10.1177/0363546507312381
Feller J, Webster KE. Return to sport following anterior cruciate ligament reconstruction. Int Orthop. 2013 Feb;37(2):285–290. doi: https://www.doi.org/10.1007/s00264-012-1690-7. DOI: https://doi.org/10.1007/s00264-012-1690-7
Shelbourne KD, Benner RW, Gray T. Return to sports and subsequent injury rates after revision anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med. 2014 Jun;42(6):1395-1400. doi: https://www.doi.org/10.1177/0363546514524921. DOI: https://doi.org/10.1177/0363546514524921
Ortiz E, Zicaro JP, Garcia Mansilla I, Yacuzzi C, Costa-Paz M. Revision anterior cruciate ligament reconstruction: Return to sports at a minimum 5-year follow-up. World J Orthop. 2022 Sep;13(9):812-824. doi: https://www.doi.org/10.5312/wjo.v13.i9.812. DOI: https://doi.org/10.5312/wjo.v13.i9.812
Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011 Jun;45(7):596-606. doi: https://www.doi.org/10.1136/bjsm.2010.076364. DOI: https://doi.org/10.1136/bjsm.2010.076364
Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013 Jul;41(7):1549–1558. doi: https://www.doi.org/10.1177/0363546513489284.
Griffith TB, Allen BJ, Levy BA, Stuart MJ, Dahm DL. Outcomes of repeat revision anterior cruciate ligament reconstruction. Am J Sports Med. 2013 Jun;41(6):1296–1301. doi: https://www.doi.org/10.1177/0363546513482568.
Ardern CL, Österberg A, Tagesson S, Gauffin H, Webster KE, Kvist J. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med. 2014 Dec;48(22):1613-1619. doi: https://www.doi.org/10.1136/bjsports-2014-093842. DOI: https://doi.org/10.1136/bjsports-2014-093842
Griffith TB, Allen BJ, Levy BA, Stuart MJ, Dahm DL. Outcomes of repeat revision anterior cruciate ligament reconstruction. Am J Sports Med. 2013 Jun;41(6):1296–1301. doi: https://www.doi.org/10.1177/0363546513482568. DOI: https://doi.org/10.1177/0363546513482568
Lai CCH, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med. 2018 Jan;52(2):128–138. doi: https://www.doi.org/10.1136/bjsports-2016-096836. DOI: https://doi.org/10.1136/bjsports-2016-096836
Webster KE, Feller JA, Lambros C. Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport. 2008 Feb;9(1):9–15. doi: DOI: https://doi.org/10.1016/j.ptsp.2007.09.003
Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013 Jul;41(7):1549–1558. doi: DOI: https://doi.org/10.1177/0363546513489284
Sonesson S, Kvist J, Ardern C, Österberg A, Silbernagel KG. Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surg Sports Traumatol Arthrosc. 2017 May;25(5):1375-1384. doi: https://www.doi.org/10.1007/s00167-016-4294-8. DOI: https://doi.org/10.1007/s00167-016-4294-8
Solie BS, Tollefson LV, Doney CP, O'Keefe JMJ, Thompson WC, LaPrade RF. Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations. Int J Sports Med. 2024 Jul;45(8):572-588. doi: https://www.doi.org/10.1055/a-2270-3233. DOI: https://doi.org/10.1055/a-2270-3233
Chen JL, Allen CR, Stephens TE, Haas AK, Huston LJ, Wright RW, et al. Differences in mechanisms of failure, intraoperative findings, and surgical characteristics between single- and multiple-revision ACL reconstructions: a MARS cohort study. Am J Sports Med. 2013 Jul;41(7):1571–1578. doi: https://www.doi.org/10.1177/0363546513487980.
El Khoury G, Hardy A, Saint-Etienne A, Saghbiny E, Meyer A, et al. Return to sport after revision ACL reconstruction: a comparative cohort study of outcomes after single- versus multiple-revision surgeries. Orthop J Sports Med. 2022 Nov;10(11):23259671221133762. doi: https://www.doi.org/10.1177/23259671221133762. DOI: https://doi.org/10.1177/23259671221133762
Levine BD, Baggish AL, Kovacs RJ, Link MS, Maron MS, Mitchell JH. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 1: classification of sports: dynamic, static, and impact: a scientific statement from the American Heart Association and American College of Cardiology. Circulation. 2015 Dec;132(22):e262-e266. doi: https://www.doi.org/10.1161/CIR.0000000000000237. DOI: https://doi.org/10.1161/CIR.0000000000000237
Lefevre N, Klouche S, Mirouse G, Herman S, Gerometta A, Bohu Y. Return to sport after primary and revision anterior cruciate ligament reconstruction: a prospective comparative study of 552 patients from the FAST cohort. Am J Sports Med. 2017 Jan;45(1):34–41. doi: https://www.doi.org/10.1177/0363546516660075. DOI: https://doi.org/10.1177/0363546516660075
Helito CP, da Silva AGM, Guimarães TM, Sobrado MF, Pécora JR, Camanho GL. Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction. Knee Surg Relat Res. 2022 May;34(1):24. doi: https://www.doi.org/10.1186/s43019-022-00153-3. DOI: https://doi.org/10.1186/s43019-022-00153-3
Buda R, Ruffilli A, Di Caprio F, Ferruzzi A, Faldini C, Cavallo M, et al. Allograft salvage procedure in multiple-revision anterior cruciate ligament reconstruction. Am J Sports Med. 2013 Feb;41(2):402–410. doi: https://www.doi.org/10.1177/0363546512471025. DOI: https://doi.org/10.1177/0363546512471025
Dini F, Tecame A, Ampollini A, Adravanti P. Multiple ACL revision: failure analysis and clinical outcomes. J Knee Surg. 2021 Jul;34(8):801–809. doi: https://www.doi.org/10.1055/s-0039-3400741. DOI: https://doi.org/10.1055/s-0039-3400741
D’Ambrosi R, Meena A, Raj A, Ursino N, Formica M, Herbort M, et al. Multiple revision anterior cruciate ligament reconstruction: not the best but still good. Knee Surg Sports Traumatol Arthrosc. 2023 Feb;31(2):559–571. doi: https://www.doi.org/10.1007/s00167-022-07197-8. DOI: https://doi.org/10.1007/s00167-022-07197-8
MARS Group; Bigouette JP, Owen EC, Lantz BBA, Hoellrich RG, Huston LJ, et al. Relationship between sports participation after revision anterior cruciate ligament reconstruction and 2-year patient-reported outcome measures. Am J Sports Med. 2019 Jul;47(9):2056–2066. doi: https://www.doi.org/10.1177/0363546519856348.
Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, MOON Consortium, Spindler KP. Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med. 2015 Jul;43(7):1583–1590. doi: https://www.doi.org/10.1177/0363546515578836. DOI: https://doi.org/10.1177/0363546515578836
Wright RW, Magnussen RA, Dunn WR, Spindler KP. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am. 2011 Jun;93(12):1159–1165. doi: https://www.doi.org/10.2106/JBJS.J.00898. DOI: https://doi.org/10.2106/JBJS.J.00898
Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014 Jul;42(7):1567–1573. doi: https://www.doi.org/10.1177/0363546514530088. DOI: https://doi.org/10.1177/0363546514530088
Ardern CL, Taylor NF, Feller JA, Webster KE. 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. Br J Sports Med. 2014 Nov;48(21):1543–1552. doi: https://www.doi.org/10.1136/bjsports-2013-093398. DOI: https://doi.org/10.1136/bjsports-2013-093398
Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010 Oct;38(10):1968–1978. doi: https://www.doi.org/10.1177/0363546510376053. DOI: https://doi.org/10.1177/0363546510376053
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