Price Meghan J, Tuca Maria, Cordasco Frank A, Green Daniel W
aHospital for Special Surgery, New York, NY, USA bDepartment of Orthopaedic Surgery, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile.
Curr Opin Pediatr. 2017 Feb;29(1):55-64. doi: 10.1097/MOP.0000000000000444.
As anterior cruciate ligament (ACL) injury is becoming increasingly prevalent in the population of active children and young adolescents, it is crucial to be aware of both the modifiable and nonmodifiable factors that place this population at increased ACL injury risk. Historically, there has not been a definitive consensus on all of these risk factors-particularly the nonmodifiable ones.
The present review has accumulated the most recent evidence for the nonmodifiable risk factors in ACL injury focusing particularly on female gender, generalized joint laxity, knee recurvatum, increased lateral tibial slope, decreased intercondylar notch width, structural lower extremity valgus, limb length discrepancy, family history, and history of contralateral knee ACL injury.
Physicians should be aware of the nonmodifiable risk factors for ACL tears in active children and adolescents and should also encourage avoidance of modifiable risk factors in this population. Young athletes with nonmodifiable risk factors are at a particularly increased risk of recurrent injury following ACL reconstruction (ACLR). We believe that a primary extra-articular augmentation via iliotibial band tenodesis at the same time of ACLR may decrease the rate of reinjury for the high risk athlete with multiple nonmodifiable risk factors.
由于前交叉韧带（ACL）损伤在活跃的儿童和青少年人群中越来越普遍，了解使该人群ACL损伤风险增加的可改变和不可改变因素至关重要。从历史上看，对于所有这些风险因素，尤其是不可改变的因素，尚未达成明确的共识。
本综述收集了ACL损伤中不可改变风险因素的最新证据，特别关注女性性别、全身性关节松弛、膝反屈、胫骨外侧坡度增加、髁间切迹宽度减小、结构性下肢外翻、肢体长度差异、家族史以及对侧膝关节ACL损伤史。
医生应了解活跃儿童和青少年ACL撕裂的不可改变风险因素，还应鼓励该人群避免可改变的风险因素。具有不可改变风险因素的年轻运动员在ACL重建（ACLR）后再次受伤的风险尤其增加。我们认为，在ACLR同时通过髂胫束腱固定进行一次主要的关节外增强术，可能会降低具有多种不可改变风险因素的高风险运动员的再损伤率。
