DeMorat Gene, Weinhold Paul, Blackburn Troy, Chudik Steven, Garrett William
Shore Orthopaedic University Associates, Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Am J Sports Med. 2004 Mar;32(2):477-83. doi: 10.1177/0363546503258928.
The force responsible for noncontact anterior cruciate ligament (ACL) injuries remains controversial. The patella tendon to tibial shaft angle causes an anterior tibial shear force with quadriceps activation.
An aggressive quadriceps contraction can injure the ACL.
The authors characterized noncontact ACL injury and kinematics with aggressive quadriceps loading. Thirteen fresh-frozen knees were potted in a jig held in 20 degrees of flexion while a 4500 N quadriceps contraction was simulated. Knee kinematics were recorded. A KT-1000 arthrometer and a simulated active quadriceps test assessed anterior displacement. Statistics were performed using paired t tests and 1-way analysis of variance.
Kinematics revealed the following mean values: anterior displacement, 19.5 mm; valgus, 2.3 degrees; and internal rotation, 5.5 degrees. Mean KT-1000 and active quadriceps test differences were 4.0 mm and 2.7 mm, respectively (statistically significant P =.002 and P =.002). Six knees showed gross ACL injury at the femoral insertion. Based on ACL injury, KT-1000 differences were statistically significant (P =.029).
Aggressive quadriceps loading, with the knee in slight flexion, produces significant anterior tibial translation and ACL injury. This suggests that the quadriceps is the intrinsic force in noncontact ACL injuries, producing a model for further investigation.
导致非接触性前交叉韧带（ACL）损伤的作用力仍存在争议。髌腱与胫骨干的角度在股四头肌激活时会产生胫骨前方的剪切力。
股四头肌的强力收缩会损伤ACL。
作者通过强力股四头肌负荷来描述非接触性ACL损伤及运动学特征。将13个新鲜冷冻膝关节固定在夹具中，保持20度屈曲，同时模拟4500N的股四头肌收缩。记录膝关节运动学数据。使用KT - 1000关节测量仪和模拟主动股四头肌试验评估前方移位。采用配对t检验和单因素方差分析进行统计学分析。
运动学数据显示以下平均值：前方移位19.5mm；外翻2.3度；内旋5.5度。KT - 1000和主动股四头肌试验的平均差异分别为4.0mm和2.7mm（P值分别为0.002和0.002，具有统计学意义）。6个膝关节在股骨附着点处出现明显的ACL损伤。基于ACL损伤情况，KT - 1000差异具有统计学意义（P = 0.029）。
膝关节处于轻度屈曲时，股四头肌的强力负荷会导致明显的胫骨前方平移和ACL损伤。这表明股四头肌是非接触性ACL损伤中的内在作用力，为进一步研究提供了一个模型。
