Shimokochi Yohei, Shultz Sandra J
Osaka University of Health and Sport Sciences, Sennan-gun, Osaka, Japan.
J Athl Train. 2008 Jul-Aug;43(4):396-408. doi: 10.4085/1062-6050-43.4.396.
To examine and summarize previous retrospective and observational studies assessing noncontact anterior cruciate ligament (ACL) injury mechanisms and to examine such reported ACL injury mechanisms based on ACL loading patterns due to knee loadings reported in in vivo, in vitro, and computer simulation studies.
We searched MEDLINE from 1950 through 2007 using the key words anterior cruciate ligament + injury + mechanisms; anterior cruciate ligament + injury + mechanisms + retrospective; and anterior cruciate ligament + injury + mechanisms + video analysis.
We selected retrospective studies and observational studies that specifically examined the noncontact ACL injury mechanisms (n = 7) and assessed ACL loading patterns in vivo, in vitro, and using computer simulations (n = 33).
The motion patterns reported as noncontact ACL injury mechanisms in retrospective and observational studies were assessed and critically compared with ACL loading patterns measured during applied external or internal (or both) forces or moments to the knee.
Noncontact ACL injuries are likely to happen during deceleration and acceleration motions with excessive quadriceps contraction and reduced hamstrings co-contraction at or near full knee extension. Higher ACL loading during the application of a quadriceps force when combined with a knee internal rotation moment compared with an external rotation moment was noted. The ACL loading was also higher when a valgus load was combined with internal rotation as compared with external rotation. However, because the combination of knee valgus and external rotation motions may lead to ACL impingement, these combined motions cannot be excluded from the noncontact ACL injury mechanisms. Further, excessive valgus knee loads applied during weight-bearing, decelerating activities also increased ACL loading.
The findings from this review lend support to ACL injury prevention programs designed to prevent unopposed excessive quadriceps force and frontal-plane or transverse-plane (or both) moments to the knee and to encourage increased knee flexion angle during sudden deceleration and acceleration tasks.
回顾和总结以往评估非接触性前交叉韧带（ACL）损伤机制的回顾性研究和观察性研究，并根据体内、体外和计算机模拟研究中报道的膝关节负荷导致的ACL负荷模式，研究此类报道的ACL损伤机制。
我们使用关键词“前交叉韧带+损伤+机制”；“前交叉韧带+损伤+机制+回顾性”；以及“前交叉韧带+损伤+机制+视频分析”，检索了1950年至2007年的MEDLINE数据库。
我们选择了专门研究非接触性ACL损伤机制的回顾性研究和观察性研究（n = 7），以及评估体内、体外和使用计算机模拟的ACL负荷模式的研究（n = 33）。
评估回顾性研究和观察性研究中报道的作为非接触性ACL损伤机制的运动模式，并与在对膝关节施加外部或内部（或两者）力或力矩期间测量的ACL负荷模式进行严格比较。
非接触性ACL损伤很可能发生在减速和加速运动期间，此时股四头肌过度收缩，而腘绳肌在膝关节接近或完全伸展时协同收缩减少。与外旋力矩相比，当股四头肌力量与膝关节内旋力矩同时作用时，ACL负荷更高。与外旋相比，当外翻负荷与内旋结合时，ACL负荷也更高。然而，由于膝关节外翻和外旋运动的组合可能导致ACL撞击，这些组合运动不能从非接触性ACL损伤机制中排除。此外，在负重、减速活动期间施加的过度膝关节外翻负荷也会增加ACL负荷。
本综述的结果支持旨在预防膝关节无对抗的过度股四头肌力量以及额状面或横断面（或两者）力矩的ACL损伤预防计划，并鼓励在突然减速和加速任务期间增加膝关节屈曲角度。
