Zazulak Bohdanna T, Hewett Timothy E, Reeves N Peter, Goldberg Barry, Cholewicki Jacek
Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, Connecticut 06510, USA.
Am J Sports Med. 2007 Jul;35(7):1123-30. doi: 10.1177/0363546507301585. Epub 2007 Apr 27.
Female athletes are at significantly greater risk of anterior cruciate ligament (ACL) injury than male athletes in the same high-risk sports. Decreased trunk (core) neuromuscular control may compromise dynamic knee stability.
(1) Increased trunk displacement after sudden force release would be associated with increased knee injury risk; (2) coronal (lateral), not sagittal, plane displacement would be the strongest predictor of knee ligament injury; (3) logistic regression of factors related to core stability would accurately predict knee, ligament, and ACL injury risk; and (4) the predictive value of these models would differ between genders.
Cohort study (prognosis); Level of evidence, 2.
In this study, 277 collegiate athletes (140 female and 137 male) were prospectively tested for trunk displacement after a sudden force release. Analysis of variance and multivariate logistic regression identified predictors of risk in athletes who sustained knee injury.
Twenty-five athletes (11 female and 14 male) sustained knee injuries over a 3-year period. Trunk displacement was greater in athletes with knee, ligament, and ACL injuries than in uninjured athletes (P < .05). Lateral displacement was the strongest predictor of ligament injury (P = .009). A logistic regression model, consisting of trunk displacements, proprioception, and history of low back pain, predicted knee ligament injury with 91% sensitivity and 68% specificity (P = .001). This model predicted knee, ligament, and ACL injury risk in female athletes with 84%, 89%, and 91% accuracy, but only history of low back pain was a significant predictor of knee ligament injury risk in male athletes.
Factors related to core stability predicted risk of athletic knee, ligament, and ACL injuries with high sensitivity and moderate specificity in female, but not male, athletes.
在相同的高风险运动项目中，女性运动员前交叉韧带（ACL）损伤的风险显著高于男性运动员。躯干（核心）神经肌肉控制能力下降可能会损害膝关节的动态稳定性。
（1）突然释放力量后躯干位移增加与膝关节损伤风险增加相关；（2）冠状面（外侧）而非矢状面的位移是膝关节韧带损伤的最强预测指标；（3）与核心稳定性相关因素的逻辑回归能够准确预测膝关节、韧带和ACL损伤风险；（4）这些模型的预测价值在性别之间存在差异。
队列研究（预后）；证据等级，2级。
在本研究中，对277名大学生运动员（140名女性和137名男性）进行前瞻性测试，以测量突然释放力量后的躯干位移。方差分析和多变量逻辑回归确定了膝关节受伤运动员的风险预测指标。
在3年期间，25名运动员（11名女性和14名男性）发生了膝关节损伤。膝关节、韧带和ACL损伤的运动员的躯干位移大于未受伤的运动员（P <.05）。外侧位移是韧带损伤的最强预测指标（P =.009）。由躯干位移、本体感觉和腰痛病史组成的逻辑回归模型预测膝关节韧带损伤的灵敏度为91%，特异度为68%（P =.001）。该模型预测女性运动员膝关节、韧带和ACL损伤风险的准确率分别为84%、89%和91%，但在男性运动员中，只有腰痛病史是膝关节韧带损伤风险的显著预测指标。
与核心稳定性相关的因素在女性运动员中能够以高灵敏度和中等特异度预测运动性膝关节、韧带和ACL损伤风险，但在男性运动员中并非如此。
