膝关节前交叉韧带损伤修复及研究现状

在查阅近年来国内外许多有关膝关节前交叉韧带损伤修复的研究报告的基础上，对前交叉韧带损伤的流行病学资料、功能解剖、诊断及治疗和并发症等资料进行综述，以便全面了解ACL损伤的研究现状。     

Return to play following muscle injuries in professional footballers

Abstract

This prospective cohort study described return-to-play (RTP) data for different types of muscle injuries in male elite-level football players in Europe. Eighty-nine European professional teams were followed between 2001 and 2013. Team medical staff recorded individual player exposure and time-loss injuries. A total of 17,371 injuries occurred, including 5603 (32%) muscle injuries. From 2007, we received results from 386 magnetic resonance imaging (MRI) examinations, and radiological grading was performed. A negative MRI was associated with shorter recovery time (6 ± 7 days). Lay-off days were correlated with MRI grading of thigh muscle injuries (P < 0.001). Among hamstring injuries, 83% occurred to the biceps femoris, 12% affected the semimembranosus and 5% the semitendinosus. Recurrence rate was higher among biceps femoris injuries (18%) compared with semitendinosus and semimembranosus injuries (2% together). Groin muscle injuries caused shorter median absence (9 days) than hamstring (13 days; P < 0.001), quadriceps (12 days; P < 0.001) and calf muscle (13 days; P < 0.001) injuries. Overall, we found that MRI was valuable for prognosticating RTP, with radiological grading associated with lay-off times after injury. Re-injuries were common in biceps femoris injuries but rare in semitendinosus and semimembranosus injuries.     

生物力学在确定膝关节前交叉韧带损伤危险因素中的应用

膝关节前交叉韧带（Anterior Cruciate Ligament,ACL）是膝关节4个主要韧带之一。其主要功能是限制胫骨的前移,在膝关节伸展时防止膝内外翻,并与后交叉韧带共同调整膝关节的旋转复位。     

ACL损伤及其康复措施的研究进展

目的:了解人体前交叉韧带(anterior cruciate ligament,ACL)的损伤机制,并对其损伤治疗与康复手段进行研究,为日后更好的康复手段的探究奠定基础。方法:通过在中国知网与Pub Med数据库中查阅大量中外文献资料进行综述。结果与结论:ACL损伤多是膝关节强力过伸或强力外展造成的。ACL损伤后,膝关节将发生异常活动,易引发ODonoghue三联症。有80%的膝关节韧带手术涉及ACL手术,且手术后还会产生严重的后遗症。随着人们对ACL损伤关注度的增高,手术治疗后伴随的康复治疗手段也日新月异,并证实使用新型康复手段的实验组的康复效果显著高于常规康复组。     

功能性训练在康复体能训练中的应用

通过步态分析、等速力量、功能性动作（FMS）和十字韧带功能测试等综合手段,对运动员进行前交叉韧带（ACL）损伤后的评估,根据得到的结果分析并对进行相应的康复体能训练（包括本体感觉训练、柔韧性训练、平衡训练、核心力量训练和下肢离心力量训练和plyometric爆发力训练）。发现通过针对性的功能性训练,可有效降低运动员ACL损伤的再发生、缩短损伤后竞技能力与运动表现恢复周期,体现了其在康复体能训练方面的价值。     

运动员前交叉韧带重建术及重返赛场的康复策略

通过国内外文献资料,并结合运动康复实践,从运动员ACL手术类型、合并损伤类型及处理、ACL重建术后康复周期的划分及具体康复目标与措施等方面进行详细分析,为ACL重建术后的运动员最终健康地重返赛场提供理论与实践依据。     

健美操运动员前交叉韧带损伤的康复方案研究——Ⅰ度损伤的保守治疗

膝关节是人体负重和运动的主要关节,前交叉韧带(ACL)损伤是膝关节最常见运动损伤之一,而健美操运动也是造成膝关节前交叉韧带损伤的项目之一,本文通过运用文献综述的方法,广泛收集有关膝关节ACL损伤的基本理论及防治知识,通过前交叉韧带的生理解剖结构,并结合健美操项目的运动特点来分析造成前交叉韧带一度损伤的原因及根据原因提出预防措施,针对前交叉韧带一度损伤的早、中、晚三期的病理演变特征提出康复方案,对以后前交叉韧带一度损伤保守治疗的快速康复提供理论基础,并对以后健美操训练中前交叉韧带损伤的预防和韧带重建术后康复训练有重要意义。     

The effects of mid-flight whole-body and trunk rotation on landing mechanics: implications for anterior cruciate ligament injuries

ABSTRACT

The purpose was to quantify the effects of mid-flight whole-body and trunk rotation on knee mechanics in a double-leg landing. Eighteen male and 20 female participants completed a jump-landing-jump task in five conditions: no rotation, testing leg ipsilateral or contralateral (WBRC) to the whole-body rotation direction, and testing leg ipsilateral (TRI) or contralateral to the trunk rotation direction. The WBRC and TRI conditions demonstrated decreased knee flexion and increased knee abduction angles at initial contact (2.6 > Cohen’s dz > 0.3) and increased peak vertical ground reaction forces and knee adduction moments during the 100 ms after landing (1.7 > Cohen’s dz > 0.3). The TRI condition also showed the greatest knee internal rotation angles at initial contact and peak knee abduction and internal rotation angles and peak knee extension moments during the 100 ms after landing (2.0 > Cohen’s dz > 0.5). Whole-body rotation increased contralateral knee loading because of its primary role in decelerating medial-lateral velocities. Trunk rotation resulted in the greatest knee loading for the ipsilateral knee due to weight shifting and mechanical coupling between the trunk and lower extremities. These findings may help understand altered trunk motion in anterior cruciate ligament injuries.     

Kinematic effects of repeated turns while running

Abstract

In team sports, non-contact ACL and MCL injuries occur during abrupt changes of direction, like turns or cutting manoeuvres. Fatigue affects dynamic neuromuscular control and increases knee injury risk. This study analysed how lower limb joints and centre-of-mass kinematics are affected throughout a high-intensity running protocol involving repeated 180°-turns. Twenty young men (18–23 years, BMI: 20.8–24.4?kg?m^?2) completed a 5-m shuttle running trial lasting 5?min at an average speed of 75% of their maximum aerobic speed. During the test, cardio-metabolic parameters were obtained, together with joints and centre-of-mass kinematics, using a motion capture system. Kinematic data were compared between the first and the last minute of exercise. Perceived exercise intensity ranged from “hard” to “maximum exertion” and post-exercise lactate concentration ranged from 5.4 to 15.5?mM. The repetition of 180°-turns induced a substantial reduction of hip (?60%, p?<?.001, large effect) and knee flexion (?40%, p?=?.003, medium-to-large effect), and an increase of hip adduction and internal rotation (+25–30%, p?<?.05, medium-to-large effect). Since such movements are factors increasing the likelihood of non-contact knee injuries, we concluded that the prolonged repetition of turns may expose participants to increased risk of ligament failure. Prevention programmes should include discipline-specific neuromuscular training especially in late practices.     

The Dutch language anterior cruciate ligament return to sport after injury scale (ACL-RSI) – validity and reliability

The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes’ emotions, confidence in performance, and risk appraisal in relation to return to sport after ACL reconstruction. Aim of this study was to study the validity and reliability of the Dutch version of the ACL-RSI (ACL-RSI (NL)).

Total 150 patients, who were 3–16 months postoperative, completed the ACL-RSI(NL) and 5 other questionnaires regarding psychological readiness to return to sports, knee-specific physical functioning, kinesiophobia, and health-specific locus of control. Construct validity of the ACL-RSI(NL) was determined with factor analysis and by exploring 10 hypotheses regarding correlations between ACL-RSI(NL) and the other questionnaires. For test–retest reliability, 107 patients (5–16 months postoperative) completed the ACL-RSI(NL) again 2 weeks after the first administration. Cronbach’s alpha, Intraclass Correlation Coefficient (ICC), SEM, and SDC, were calculated. Bland–Altman analysis was conducted to assess bias between test and retest.

Nine hypotheses (90%) were confirmed, indicating good construct validity. The ACL-RSI(NL) showed good internal consistency (Cronbach’s alpha 0.94) and test–retest reliability (ICC 0.93). SEM was 5.5 and SDC was 15. A significant bias of 3.2 points between test and retest was found.

Therefore, the ACL-RSI(NL) can be used to investigate psychological factors relevant to returning to sport after ACL reconstruction.     

The role of ultrasonography in the diagnosis of anterior cruciate ligament injury: A systematic review and meta-analysis

To evaluate the value of ultrasonography in the diagnosis of anterior cruciate ligament injury (ACL injury) by conducting a systematic review and meta-analysis. A literature search was carried out in the Cochrane Library, Embase, Pubmed databases and included studies prior to April 2017. Based on inclusion and exclusion criteria, studies evaluating ultrasound to diagnose ACL injury were selected. MRI, arthroscopy and clinical-follow were considered the reference standards. The diagnostic accuracy of ultrasound was assessed using a combination of sensitivity, specificity, likelihood ratio (LR), post-test probability, diagnostic odds ratio (DOR) and by summarizing the area under the receiver operating characteristic (SROC) curve. A total of 4 studies involving 246 patients were eventually included in the analysis. In these four studies, the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, post-test probability and DOR were 90.0% (95% CI: 77–96), 97% (95% CI: 90–99), 31.08 (95% CI: 8.75–110.41), 0.11 (95% CI: 0.05–0.24), 89% (3%) and 288.81 (95% CI: 78.51–1062.48), respectively. The area under the SROC curve was 0.98 (95% CI: 0.97–0.99). Our meta-analysis showed that ultrasound can play an important role in the diagnosis of ACL injury. Because of its high sensitivity, high specificity and high diagnostic ability, ultrasound should be a part of the standard diagnostic work-up of an ACL injury.     

Mechanisms of anterior cruciate ligament injuries in elite women’s netball: a systematic video analysis

This study involved a systematic video analysis of 16 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games in order to describe the game situation, the movement patterns involved, the player’s behaviour, and a potential injury mechanism. Eight of the ACL injuries were classified as “indirect contact” and eight as “non-contact”. Two common scenarios were identified. In Scenario A the player was jumping to receive or intercept a pass and whilst competing for the ball experienced a perturbation in the air. As a result the player’s landing was unbalanced with loading occurring predominantly on the knee of the injured side. In Scenario B the player was generally in a good position at ground contact, but then noticeably altered the alignment of the trunk before the landing was completed. This involved rotating and laterally flexing the trunk without altering the alignment of the feet. Apparent knee valgus collapse on the knee of the injured side was observed in 3/6 Scenario A cases and 5/6 Scenario B cases. Players may benefit from landing training programmes that incorporate tasks that use a ball and include decision-making components or require players to learn to cope with being unbalanced.