Vargas Manuela, Chaney Grace K, Mejía Jaramillo María C, Cummings Paige, McPherson April, Bates Nathaniel A
Biomedical Engineering Universidad EIA.
Department of Orthopedic Surgery Mayo Clinic.
Int J Sports Phys Ther. 2023 Feb 1;18(1):122-131. doi: 10.26603/001c.67775. eCollection 2023.
Significant effort has gone into the identification and quantification of the underlying mechanisms of primary ACL injury. Secondary ACL injury is observed in approximately 1/4 to 1/3 of athletes who return to sport following ACL reconstruction. However, little has been done to evaluate the mechanisms and playing circumstances surrounding these repeat injuries.
HYPOTHESIS/PURPOSE: The purpose of this study was to characterize the mechanisms of non-contact secondary ACL injuries using video analysis. It was hypothesized that in video recordings of secondary ACL injury, athletes would exhibit greater frontal plane hip and knee angles, but not greater hip and knee flexion, at 66 ms following initial contact (IC) as compared to at IC and 33ms following IC.
Cross-Sectional Study.
Twenty-six video recordings of competitive athletes experiencing secondary ACL ruptures via noncontact mechanisms were analyzed for lower extremity joint kinematics, playing situation, and player attention. Kinematics were assessed at IC as well as 33 ms (1 broadcast frame) and 66 ms (2 broadcast frames) following IC.
Knee flexion and knee frontal plane angles were greater at 66 ms than IC (p ≤ 0.03). Hip, trunk, and ankle frontal plane angles were not greater at 66 ms than IC (p ≥ 0.22). Injuries were distributed between attacking play (n=14) and defending (n=8). Player attention was most commonly focused on the ball (n=12) or an opponent (n=7). A single-leg landing accounted for just over half of the injuries (54%), while a cutting motion accounted for the remainder of the injuries (46%).
Secondary ACL injury was most likely to occur during landing or a sidestep cut with player attention external to their own body. Knee valgus collapse combined with limited hip motion was identified in the majority of secondary injuries.
Level IIIb.
人们在识别和量化原发性前交叉韧带损伤的潜在机制方面付出了巨大努力。在接受前交叉韧带重建后恢复运动的运动员中，约四分之一至三分之一会出现继发性前交叉韧带损伤。然而，对于这些重复性损伤的机制和运动环境的评估却很少。
假设/目的：本研究的目的是通过视频分析来描述非接触性继发性前交叉韧带损伤的机制。研究假设是，在继发性前交叉韧带损伤的视频记录中，与初始接触（IC）时以及IC后33毫秒相比，运动员在初始接触后66毫秒时会表现出更大的额面髋关节和膝关节角度，但髋关节和膝关节屈曲角度不会更大。
横断面研究。
对26名通过非接触机制发生继发性前交叉韧带断裂的竞技运动员的视频记录进行分析，以评估下肢关节运动学、运动情况和运动员注意力。在IC时以及IC后33毫秒（1个播放帧）和66毫秒（2个播放帧）评估运动学。
膝关节屈曲和膝关节额面角度在66毫秒时大于IC时（p≤0.03）。髋关节、躯干和踝关节额面角度在66毫秒时不大于IC时（p≥0.22）。损伤分布在进攻（n = 14）和防守（n = 8）之间。运动员注意力最常集中在球（n = 12）或对手（n = 7）上。单腿落地占损伤的一半以上（54%），而变向动作占其余损伤（46%）。
继发性前交叉韧带损伤最有可能发生在落地或侧步变向时，且运动员注意力集中在自身身体外部。在大多数继发性损伤中发现了膝关节外翻塌陷并伴有髋关节活动受限。
IIIb级。
