Ueno Ryo, Navacchia Alessandro, Schilaty Nathan D, Myer Gregory D, Hewett Timothy E, Bates Nathaniel A
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Sport Science, University of Innsbruck, Innsbruck, Austria.
Orthop J Sports Med. 2021 Sep 29;9(9):23259671211034487. doi: 10.1177/23259671211034487. eCollection 2021 Sep.
BACKGROUND: Anterior cruciate ligament (ACL) injury reduction training has focused on lower body strengthening and landing stabilization. In vitro studies have shown that quadriceps forces increase ACL strain, and hamstring forces decrease ACL strain. However, the magnitude of the effect of the quadriceps and hamstrings forces on ACL loading and its timing during in vivo landings remains unclear. PURPOSE: To investigate the effect and timing of knee muscle forces on ACL loading during landing. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 13 young female athletes performed drop vertical jump trials, and their movements were recorded with 3-dimensional motion capture. Lower limb joint motion and muscle forces were estimated with OpenSim and applied to a musculoskeletal finite element (FE) model to estimate ACL loading during landings. The FE simulations were performed with 5 different conditions that included/excluded kinematics, ground-reaction force (GRF), and muscle forces. RESULTS: Simulation of landing kinematics without GRF or muscle forces yielded an estimated median ACL strain and force of 5.1% and 282.6 N. Addition of GRF to kinematic simulations increased ACL strain and force to 6.8% and 418.4 N ( < .05). Addition of quadriceps force to kinematics + GRF simulations nonsignificantly increased ACL strain and force to 7.2% and 478.5 N. Addition of hamstrings force to kinematics + GRF simulations decreased ACL strain and force to 2.6% and 171.4 N ( < .001). Addition of all muscles to kinematics + GRF simulations decreased ACL strain and force to 3.3% and 195.1 N ( < .001). With hamstrings force, ACL loading decreased from initial contact (time of peak: 1-18 milliseconds) while ACL loading without hamstrings force peaked at 47 to 98 milliseconds after initial contact ( = .024-.001). The knee flexion angle increased from 20.9° to 73.1° within 100 milliseconds after initial contact. CONCLUSION: Hamstrings activation had greater effect relative to GRF and quadriceps activation on ACL loading, which significantly decreased and regulated the magnitude and timing of ACL loading during in vivo landings. CLINICAL RELEVANCE: Clinical training should focus on strategies that influence increased hamstrings activation during landing to reduce ACL loads.
背景：前交叉韧带（ACL）损伤预防训练主要集中在下半身力量强化和落地稳定性训练。体外研究表明，股四头肌力量会增加ACL应变，而腘绳肌力量会降低ACL应变。然而，股四头肌和腘绳肌力量对体内落地时ACL负荷的影响程度及其时机仍不清楚。 目的：研究落地过程中膝关节肌肉力量对ACL负荷的影响及其时机。 研究设计：描述性实验室研究。 方法：共有13名年轻女性运动员进行了垂直纵跳试验，并用三维运动捕捉技术记录了她们的动作。使用OpenSim估计下肢关节运动和肌肉力量，并将其应用于肌肉骨骼有限元（FE）模型，以估计落地过程中的ACL负荷。FE模拟在5种不同条件下进行，包括/排除运动学、地面反作用力（GRF）和肌肉力量。 结果：在没有GRF或肌肉力量的情况下模拟落地运动学，估计ACL应变和力的中位数分别为5.1%和282.6N。在运动学模拟中加入GRF后，ACL应变和力增加到6.8%和418.4N（P<0.05）。在运动学+GRF模拟中加入股四头肌力量后，ACL应变和力无显著增加，分别为7.2%和478.5N。在运动学+GRF模拟中加入腘绳肌力量后，ACL应变和力降低到2.6%和171.4N（P<0.001）。在运动学+GRF模拟中加入所有肌肉力量后，ACL应变和力降低到3.3%和195.1N（P<0.001）。有腘绳肌力量时，ACL负荷从初始接触时开始下降（峰值时间：1-18毫秒），而没有腘绳肌力量时，ACL负荷在初始接触后47至98毫秒达到峰值（P=0.024-0.001）。初始接触后100毫秒内，膝关节屈曲角度从20.9°增加到73.1°。 结论：相对于GRF和股四头肌激活，腘绳肌激活对ACL负荷的影响更大，可显著降低并调节体内落地时ACL负荷的大小和时机。 临床意义：临床训练应侧重于采用能增加落地时腘绳肌激活的策略，以降低ACL负荷。
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