Joshua Dworsky-Fried, Satyavenkata Kotipalli, Prushoth Vivekanantha, Meshal Alomari, Sachin Tapasvi, Gilbert Moatshe, Ryan Martin, Darren de Sa
{"title":"膝关节多韧带损伤手术治疗后恢复运动的比率比先前描述的高，但高度异质性：一项系统综述。","authors":"Joshua Dworsky-Fried, Satyavenkata Kotipalli, Prushoth Vivekanantha, Meshal Alomari, Sachin Tapasvi, Gilbert Moatshe, Ryan Martin, Darren de Sa","doi":"10.1016/j.arthro.2025.06.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To provide an updated overview of return to sport (RTS) and return to work (RTW) following surgical management of multi-ligament knee injuries (MLKIs).</p><p><strong>Methods: </strong>A search was conducted across MEDLINE, Embase, and PubMed from inception to August 26th, 2024. Studies published after 2018 that reported on rates of RTS or RTW following multi-ligament knee reconstruction were included. PRISMA guidelines were followed, and a quality assessment was performed using the MINORS criteria. Data on study characteristics, demographics, and surgical details were extracted. Rates of RTS or RTW at the same or at any level of participation were recorded. Random effects models were used to generate forest plots.</p><p><strong>Results: </strong>Fifteen studies reported on RTS, with rates ranging from 41.2% to 100% when investigating RTS at any level. Thirteen studies reported rates of return to pre-injury level, ranging from 5.9% to 100%. RTS rates at any level and pre-injury level had higher ceilings than shown in a prior systematic review. Time taken to RTS ranged from 6.7 to 24.9 months. Twelve studies reported on RTW at any capacity, with rates ranging from 41% to 100%. Seven studies reported rates of RTW to pre-injury capacities, ranging from 39.3% to 100%. For both RTS and RTW outcomes, high heterogeneities precluded pooled estimates. Time taken to RTW ranged from 2.4 to 24.8 months. Substantially lower RTW rates were associated with multi-trauma dislocations and sedentary occupations.</p><p><strong>Conclusions: </strong>Rates of RTS at any level and pre-injury level ranged from 41.2% to 100% and 5.9% to 100% respectively, with corresponding heterogeneity values of 91% and 83%. These rates have higher ceilings than reported in previous systematic reviews. Currently, there is insufficient evidence to recommend one surgical approach over another. Future research should employ standardized RTS criteria, postoperative protocols and outcome measures to better help guide surgical decision-making.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Rates of Return to Sport Following Surgical Management of Multi-ligament Knee Injuries Are Higher Than Previously Described Yet Highly Heterogeneous: A Systematic Review.\",\"authors\":\"Joshua Dworsky-Fried, Satyavenkata Kotipalli, Prushoth Vivekanantha, Meshal Alomari, Sachin Tapasvi, Gilbert Moatshe, Ryan Martin, Darren de Sa\",\"doi\":\"10.1016/j.arthro.2025.06.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To provide an updated overview of return to sport (RTS) and return to work (RTW) following surgical management of multi-ligament knee injuries (MLKIs).</p><p><strong>Methods: </strong>A search was conducted across MEDLINE, Embase, and PubMed from inception to August 26th, 2024. Studies published after 2018 that reported on rates of RTS or RTW following multi-ligament knee reconstruction were included. PRISMA guidelines were followed, and a quality assessment was performed using the MINORS criteria. Data on study characteristics, demographics, and surgical details were extracted. Rates of RTS or RTW at the same or at any level of participation were recorded. Random effects models were used to generate forest plots.</p><p><strong>Results: </strong>Fifteen studies reported on RTS, with rates ranging from 41.2% to 100% when investigating RTS at any level. Thirteen studies reported rates of return to pre-injury level, ranging from 5.9% to 100%. RTS rates at any level and pre-injury level had higher ceilings than shown in a prior systematic review. Time taken to RTS ranged from 6.7 to 24.9 months. Twelve studies reported on RTW at any capacity, with rates ranging from 41% to 100%. Seven studies reported rates of RTW to pre-injury capacities, ranging from 39.3% to 100%. For both RTS and RTW outcomes, high heterogeneities precluded pooled estimates. Time taken to RTW ranged from 2.4 to 24.8 months. Substantially lower RTW rates were associated with multi-trauma dislocations and sedentary occupations.</p><p><strong>Conclusions: </strong>Rates of RTS at any level and pre-injury level ranged from 41.2% to 100% and 5.9% to 100% respectively, with corresponding heterogeneity values of 91% and 83%. These rates have higher ceilings than reported in previous systematic reviews. Currently, there is insufficient evidence to recommend one surgical approach over another. Future research should employ standardized RTS criteria, postoperative protocols and outcome measures to better help guide surgical decision-making.</p>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-06-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arthro.2025.06.006\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2025.06.006","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Rates of Return to Sport Following Surgical Management of Multi-ligament Knee Injuries Are Higher Than Previously Described Yet Highly Heterogeneous: A Systematic Review.
Purpose: To provide an updated overview of return to sport (RTS) and return to work (RTW) following surgical management of multi-ligament knee injuries (MLKIs).
Methods: A search was conducted across MEDLINE, Embase, and PubMed from inception to August 26th, 2024. Studies published after 2018 that reported on rates of RTS or RTW following multi-ligament knee reconstruction were included. PRISMA guidelines were followed, and a quality assessment was performed using the MINORS criteria. Data on study characteristics, demographics, and surgical details were extracted. Rates of RTS or RTW at the same or at any level of participation were recorded. Random effects models were used to generate forest plots.
Results: Fifteen studies reported on RTS, with rates ranging from 41.2% to 100% when investigating RTS at any level. Thirteen studies reported rates of return to pre-injury level, ranging from 5.9% to 100%. RTS rates at any level and pre-injury level had higher ceilings than shown in a prior systematic review. Time taken to RTS ranged from 6.7 to 24.9 months. Twelve studies reported on RTW at any capacity, with rates ranging from 41% to 100%. Seven studies reported rates of RTW to pre-injury capacities, ranging from 39.3% to 100%. For both RTS and RTW outcomes, high heterogeneities precluded pooled estimates. Time taken to RTW ranged from 2.4 to 24.8 months. Substantially lower RTW rates were associated with multi-trauma dislocations and sedentary occupations.
Conclusions: Rates of RTS at any level and pre-injury level ranged from 41.2% to 100% and 5.9% to 100% respectively, with corresponding heterogeneity values of 91% and 83%. These rates have higher ceilings than reported in previous systematic reviews. Currently, there is insufficient evidence to recommend one surgical approach over another. Future research should employ standardized RTS criteria, postoperative protocols and outcome measures to better help guide surgical decision-making.
期刊介绍：
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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