Departments of Physiology and Cell Biology, Sports Medicine Sports Health & Performance Institute, The Ohio State University, Columbus, Ohio, USA.
Am J Sports Med. 2011 Aug;39(8):1706-13. doi: 10.1177/0363546511400980. Epub 2011 Apr 12.
Bone bruises located on the lateral femoral condyle and posterolateral tibia are commonly associated with anterior cruciate ligament (ACL) injuries and may contribute to the high risk for knee osteoarthritis after ACL injury. The resultant footprint (location) of a bone bruise after ACL injury provides evidence of the inciting injury mechanism. Purpose/
(1) To analyze tibial and femoral articular cartilage pressure distributions during normal landing and injury simulations, and (2) to evaluate ACL strains for conditions that lead to articular cartilage pressure distributions similar to bone bruise patterns associated with ACL injury. The hypothesis was that combined knee abduction and anterior tibial translation injury simulations would demonstrate peak articular cartilage pressure distributions in the lateral femoral condyle and posterolateral tibia. The corollary hypothesis was that combined knee abduction and anterior tibial translation injury conditions would result in the highest ACL strains.
Descriptive laboratory study.
Prospective biomechanical data from athletes who subsequently suffered ACL injuries after testing (n = 9) and uninjured teammates (n = 390) were used as baseline input data for finite element model comparisons.
Peak articular pressures that occurred on the posterolateral tibia and lateral femoral condyle were demonstrated for injury conditions that had a baseline knee abduction angle of 5°. Combined planar injury conditions of abduction/anterior tibial translation, anterior tibial translation/internal tibial rotation, or anterior tibial translation/external tibial rotation or isolated anterior tibial translation, external tibial rotation, or internal tibial rotation resulted in peak pressures in the posterolateral tibia and lateral femur. The highest ACL strains occurred during the combined abduction/anterior tibial translation condition in the group that had a baseline knee abduction angle of 5°.
The results of this study support a valgus collapse as the major ACL injury mechanism that results from tibial abduction rotations combined with anterior tibial translation or external or internal tibial rotations.
Reduction of large multiplanar knee motions that include abduction, anterior translation, and internal/external tibial motions may reduce the risk for ACL injuries and associated bone bruises. In particular, prevention of an abduction knee posture during initial contact of the foot with the ground may help prevent ACL injury.
外侧股骨髁和胫骨后外侧的骨挫伤通常与前交叉韧带（ACL）损伤有关，并可能导致 ACL 损伤后膝关节骨关节炎的高风险。ACL 损伤后骨挫伤的足迹（位置）提供了引发损伤机制的证据。目的/假设：（1）分析正常着陆和损伤模拟过程中胫骨和股骨关节软骨的压力分布，（2）评估导致类似于与 ACL 损伤相关的骨挫伤模式的关节软骨压力分布的 ACL 应变。假设是，膝关节外展和胫骨前向平移联合损伤模拟将在外侧股骨髁和胫骨后外侧显示出最大的关节软骨压力分布。推论假设是，膝关节外展和胫骨前向平移联合损伤条件将导致 ACL 应变最高。
描述性实验室研究。
使用随后在测试后遭受 ACL 损伤的运动员（n=9）和未受伤队友（n=390）的前瞻性生物力学数据作为有限元模型比较的基线输入数据。
在基线膝关节外展角为 5°的情况下，出现了胫骨后外侧和外侧股骨髁的峰值关节压力。外展/胫骨前向平移、胫骨前向平移/胫骨内旋、或胫骨前向平移/胫骨外旋或单独的胫骨前向平移、胫骨外旋或胫骨内旋的平面联合损伤条件导致了胫骨后外侧和外侧股骨的峰值压力。在基线膝关节外展角为 5°的情况下，外展/胫骨前向平移联合条件下的 ACL 应变最高。
本研究结果支持在胫骨外展旋转与胫骨前向平移或内旋/外旋相结合时，外侧塌陷是 ACL 损伤的主要机制，这会导致骨挫伤。
减少包括外展、前向平移和内外胫骨运动在内的大的多平面膝关节运动可能会降低 ACL 损伤和相关骨挫伤的风险。特别是，在脚与地面初始接触时防止膝关节外展姿势可能有助于预防 ACL 损伤。
