Vij Neeraj, Tummala Sailesh, Vaughn Jeffrey, Chhabra Anikar, Salehi Hadi, Winters Jenni, Browne Amber, Glattke Kaycee, Brinkman Joseph C, Menzer Heather
Department of Orthopedic Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, USA.
Department of Orthopedic Surgery, Mayo Clinic, Phoenix, USA.
Cureus. 2023 Feb 28;15(2):e35596. doi: 10.7759/cureus.35596. eCollection 2023 Feb.
Introduction Subsequent anterior cruciate ligament (ACL) injury is more common in the pediatric population and encompasses graft failure and subsequent contralateral tears. Females are at a higher risk. The purpose of the present study was to compare the knee valgus angles at initial contact, knee extension moments, anterior and lateral knee joint forces, hip flexion angles, hip adduction moments, and ankle inversion during the drop vertical test in the uninjured extremity between adolescent males and females who had previously undergone an anterior cruciate ligament reconstruction (ACLR). Methods This IRB-approved retrospective chart review included patients aged 8-18 years who were seen at the five to seven month postoperatively following ACL reconstruction. A total of 168 patients met our inclusion criteria (86 girls and 82 boys.) Using three-dimensional motion capture technology (CORTEX software, Motion Analysis Corp., Rohnert Park, CA), data were collected while the subject performed the drop vertical test over floor-mounted force plates (FP-Stairs, AMTI, Watertown, MA) under the direct supervision of a pediatric physical therapist. The Wilcoxon rank sum was used, and p < 0.05 was considered statistically significant. Results Females demonstrated a larger average knee joint extension moment (0.31 vs 0.28 Nm/kg, p = 0.0408), a larger anterior knee joint force at initial contact (3.51 vs. 2.79, N/kg, p = 0.0458), larger average hip flexion angle (41.50° vs. 35.99°, p = 0.0005), a smaller maximum hip adduction moment (0.92 vs. 1.16, Nm/kg, p = 0.0497), and a smaller average ankle inversion angle (5.08° vs. 6.41°, p = 0.03231). No significant differences were found regarding knee abduction angle or lateral knee joint force. Conclusions The biomechanical profile of the contralateral extremity varies significantly between the genders after ACLR. In the uninjured extremity, females may have larger hip flexion angles, smaller hip adduction moments, larger anterior knee joint forces, larger knee extension moments, and smaller ankle inversion angles as compared to males after ACLR. These findings may explain the higher incidence of subsequent contralateral injury in female adolescent athletes. Further work is required to develop a composite score that determines at-risk athletes.
引言 小儿人群中后续前交叉韧带（ACL）损伤更为常见，包括移植物失效和随后的对侧撕裂。女性风险更高。本研究的目的是比较先前接受过前交叉韧带重建（ACLR）的青春期男性和女性在非受伤肢体进行下落垂直测试时的初始接触时膝外翻角度、膝关节伸展力矩、膝关节前侧和外侧力、髋关节屈曲角度、髋关节内收力矩以及踝关节内翻情况。
方法 这项经机构审查委员会（IRB）批准的回顾性图表审查纳入了年龄在8至18岁、在ACL重建术后五至七个月就诊的患者。共有168名患者符合我们的纳入标准（86名女孩和82名男孩）。使用三维运动捕捉技术（CORTEX软件，Motion Analysis Corp.，加利福尼亚州罗恩纳特帕克），在小儿物理治疗师的直接监督下，当受试者在地面安装的测力板（FP-Stairs，AMTI，马萨诸塞州沃特敦）上进行下落垂直测试时收集数据。采用威尔科克森秩和检验，p < 0.05被认为具有统计学意义。
结果 女性表现出更大的平均膝关节伸展力矩（0.31对0.28 Nm/kg，p = 0.0408）、初始接触时更大的膝关节前侧力（3.51对2.79 N/kg，p = 0.0458）、更大的平均髋关节屈曲角度（41.50°对35.99°，p = 0.0005）、更小的最大髋关节内收力矩（0.92对1.16 Nm/kg，p = 0.0497）以及更小的平均踝关节内翻角度（5.08°对6.41°，p = 0.03231）。在膝外展角度或膝关节外侧力方面未发现显著差异。
结论 ACLR后，对侧肢体的生物力学特征在性别之间存在显著差异。在非受伤肢体中，与男性相比，女性在ACLR后可能具有更大的髋关节屈曲角度、更小的髋关节内收力矩、更大的膝关节前侧力、更大的膝关节伸展力矩以及更小的踝关节内翻角度。这些发现可能解释了女性青少年运动员中后续对侧损伤发生率较高的原因。需要进一步开展工作来制定一个确定高危运动员的综合评分。
