前十字韌帶重建後的回場標準：肢體對稱性指數之考量與臨床建議

Return to play criteria after anterior cruciate ligament reconstruction: Considerations of limb symmetry index and clinical recommendations

運動傷害後如何安全的重回運動場，是運動選手、教練及運動防護員的共同目標。前十字韌帶重建後回場的再次受傷風險高，且健側腳的傷害率是傷側腳的兩倍，因此，發展出可用來確認是否可安全重回運動場的測試與評估相當重要。以條件取向設計的重回運動場測試組合（return to play test battery），是廣泛使用於前十字韌帶術後回場的決策工具，其中的肌力測試和功能性測試，多以傷側腳需恢復至對側腳的功能為基準。計算傷側腳的功能缺損程度之肢體對稱性指數（limb symmetry index）是常見的回場參考指標，但在臨床應用上仍存有潛在的問題，包含，一、未將受傷與術後的對側腳肌肉功能下降、中樞與周邊神經適應和代償性落地策略等納入考量；二、功能性測試時，傷側腳可能以其他關節或肌肉代償完成測試，而因此低估雙側對稱性的缺失；三、不適用於雙側前十字韌帶重建手術患者。因此，鑑於上述以肢體對稱性指數作為前十字韌帶術後回場臨床決策之限制，建議臨床工作者，可以加入參考受傷運動員受傷前的運動水準，或是以健康人常模數據作為回場門檻的標準之一。未來還需要更多研究，以驗證這些替代回場門檻的標準之實用性與效用。

Safely returning to sport following injuries is the common goal among athletes, coaches, and athletic trainers. However, the risk of a second anterior cruciate ligament (ACL) injury remains high after ACL reconstruction and return to play. Moreover, the rate of a second ACL injury on the uninvolved limb is twice greater than the involved limb. Thus, developing an effective return to play evaluation is crucial to enable athletes to return to sport successfully. Criterion-based return to play test battery has been widely used clinically for return to play decision-making following ACL reconstruction. The limb symmetry index is the most common criterion for quantifying functional deficiency of the involved limb for strength testing and lower extremity performance, using the uninvolved limb as a reference. However, there are potential issues regarding using limb symmetry index as a criterion for return to play decision-making, including 1) fail to consider muscle function deficient, central and peripheral neural adaptations, and compensatory landing patterns on the uninvolved limb following ACL reconstruction; 2) underestimate bilateral function deficient due to compensatory movement patterns using other joints and muscles other than knee joint; 3) may not be applicable for individuals with bilateral ACL reconstructions. Given these potential underlying issues, the current review suggests that clinicians may include normative data of healthy controls or preinjury capacity as one of the criteria that may be more appropriate for safer return to sport. Future studies are needed to verify and provide evidence to support the effectiveness and clinical utilities of these alternative returns to sport criteria following ACL reconstruction.