Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review
Abstract Background Rates of return to physical activity after anterior cruciate ligament reconstruction surgery are sub-optimal. Optimising presurgical treatment may improve return rates. The purpose of this systematic review was to identify modifiable preoperative predictors for return to physical...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-023-06489-5 |
| _version_ | 1797806909452976128 |
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| author | Hayley M. Carter Gwyn N. Lewis Benjamin E. Smith |
| author_facet | Hayley M. Carter Gwyn N. Lewis Benjamin E. Smith |
| author_sort | Hayley M. Carter |
| collection | DOAJ |
| description | Abstract Background Rates of return to physical activity after anterior cruciate ligament reconstruction surgery are sub-optimal. Optimising presurgical treatment may improve return rates. The purpose of this systematic review was to identify modifiable preoperative predictors for return to physical activity after anterior cruciate ligament reconstruction. Methods Seven electronic databases (CINAHL, MEDLINE and SPORTDiscus via EBSCOhost, AMED, PsycINFO and EMBASE via OVID and Web of Science) were searched from inception to 31 March 2023. The population of focus was adults aged 18–65 who had undergone primary anterior cruciate ligament reconstruction. Studies needed to identify at least one potential modifiable preoperative predictor variable and the relationship between the predictor(s) and return to physical activity. All time-points of assessment and study designs were included. Data extraction was completed by one reviewer and verified by a second reviewer. Two reviewers completed the risk of bias assessment using the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development and Evaluation system. Results The search identified 2281 studies, eight met the inclusion criteria. Five studies scored ‘high’, and three studies scored ‘moderate’ risk-of-bias. All preoperative predictors were of very low-quality evidence. Five different outcome measures were used to assess return to physical activity including Tegner, Marx, Physical Activity Scale, return to play at the elite level and return to preinjury level (undefined). This was measured between 1- and 10-years post-surgery. Nine preoperative physical, six psychosocial and five demographic/clinical factors were assessed and four were found to be predictive. These included quadriceps strength, psychological profile, patient estimated ability to return and graft type (patella tendon, BPTB). Conclusion Very-low level evidence suggests that increasing quadriceps strength, managing patient expectations of their treatment outcomes, improving motivation to resume preinjury activity levels and considering the use of a BPTB graft will support return to physical activity after ACLR. Trial registration This study was prospectively registered in PROSPERO: CRD 42020222567. |
| first_indexed | 2024-03-13T06:14:32Z |
| format | Article |
| id | doaj.art-6c34d2fb57d3497fb8cf993a4c3a9179 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-13T06:14:32Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-6c34d2fb57d3497fb8cf993a4c3a91792023-06-11T11:03:47ZengBMCBMC Musculoskeletal Disorders1471-24742023-06-0124111410.1186/s12891-023-06489-5Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic reviewHayley M. Carter0Gwyn N. Lewis1Benjamin E. Smith2Department of Physiotherapy, University Hospitals of Derby and Burton NHS Foundation Trust, Florence Nightingale Community HospitalAuckland University of Technology, Health and Rehabilitation Research InstituteDepartment of Physiotherapy, University Hospitals of Derby and Burton NHS Foundation Trust, Florence Nightingale Community HospitalAbstract Background Rates of return to physical activity after anterior cruciate ligament reconstruction surgery are sub-optimal. Optimising presurgical treatment may improve return rates. The purpose of this systematic review was to identify modifiable preoperative predictors for return to physical activity after anterior cruciate ligament reconstruction. Methods Seven electronic databases (CINAHL, MEDLINE and SPORTDiscus via EBSCOhost, AMED, PsycINFO and EMBASE via OVID and Web of Science) were searched from inception to 31 March 2023. The population of focus was adults aged 18–65 who had undergone primary anterior cruciate ligament reconstruction. Studies needed to identify at least one potential modifiable preoperative predictor variable and the relationship between the predictor(s) and return to physical activity. All time-points of assessment and study designs were included. Data extraction was completed by one reviewer and verified by a second reviewer. Two reviewers completed the risk of bias assessment using the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development and Evaluation system. Results The search identified 2281 studies, eight met the inclusion criteria. Five studies scored ‘high’, and three studies scored ‘moderate’ risk-of-bias. All preoperative predictors were of very low-quality evidence. Five different outcome measures were used to assess return to physical activity including Tegner, Marx, Physical Activity Scale, return to play at the elite level and return to preinjury level (undefined). This was measured between 1- and 10-years post-surgery. Nine preoperative physical, six psychosocial and five demographic/clinical factors were assessed and four were found to be predictive. These included quadriceps strength, psychological profile, patient estimated ability to return and graft type (patella tendon, BPTB). Conclusion Very-low level evidence suggests that increasing quadriceps strength, managing patient expectations of their treatment outcomes, improving motivation to resume preinjury activity levels and considering the use of a BPTB graft will support return to physical activity after ACLR. Trial registration This study was prospectively registered in PROSPERO: CRD 42020222567.https://doi.org/10.1186/s12891-023-06489-5Anterior cruciate ligamentPreoperative predictorsReturn to physical activityReturn to sport |
| spellingShingle | Hayley M. Carter Gwyn N. Lewis Benjamin E. Smith Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review BMC Musculoskeletal Disorders Anterior cruciate ligament Preoperative predictors Return to physical activity Return to sport |
| title | Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review |
| title_full | Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review |
| title_fullStr | Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review |
| title_full_unstemmed | Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review |
| title_short | Preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction (ACLR): a systematic review |
| title_sort | preoperative predictors for return to physical activity following anterior cruciate ligament reconstruction aclr a systematic review |
| topic | Anterior cruciate ligament Preoperative predictors Return to physical activity Return to sport |
| url | https://doi.org/10.1186/s12891-023-06489-5 |
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