Gaal Benjamin T, Knapik Derrick M, Karns Michael R, Salata Michael J, Voos James E
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
University Hospitals Sports Medicine Institute, Cleveland, OH, USA.
Curr Rev Musculoskelet Med. 2020 Aug;13(4):409-415. doi: 10.1007/s12178-020-09652-w.
The purpose of this review is to discuss relevant anatomy and pathoanatomy in the knee following anterior cruciate ligament reconstruction, risk factors for contralateral ACL tear, and mechanisms of contralateral injuries in the pediatric population.
Contralateral ACL rupture rates following ACL reconstruction (ACLR) range from 4% to 42%. Pediatric patients show increased risk compared with adults, likely due to inherent anatomical differences along with biomechanical and neuromuscular changes that occur in both the operative and contralateral knees following index ACLR. Pediatric athletes who return to sport more quickly have been found to be at increased risk for contralateral tears, as have athletes who participate in cutting and pivoting sports. Contralateral tears tend to occur via non-contact mechanisms. Pediatric patients are at increased risk of contralateral ACL injury following index ACL reconstruction compared with adults. Further study is warranted to determine appropriate biologic, functional, and rehabilitative parameters gauged toward preventing contralateral ACL tear while minimizing time lost from sport.
本综述旨在探讨前交叉韧带重建术后膝关节的相关解剖结构和病理解剖，对侧前交叉韧带撕裂的危险因素，以及儿童人群对侧损伤的机制。
前交叉韧带重建（ACLR）术后对侧前交叉韧带破裂率在4%至42%之间。与成人相比，儿童患者的风险增加，这可能是由于固有的解剖学差异以及在初次ACLR术后手术侧和对侧膝关节发生的生物力学和神经肌肉变化。研究发现，更快恢复运动的儿童运动员以及参加切入和旋转运动的运动员发生对侧撕裂的风险增加。对侧撕裂往往通过非接触机制发生。与成人相比，儿童患者在初次前交叉韧带重建术后发生对侧前交叉韧带损伤的风险增加。有必要进行进一步研究，以确定合适的生物学、功能和康复参数，以预防对侧前交叉韧带撕裂，同时尽量减少运动时间的损失。
