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运动相关性能量失衡(REDs)与膝关节损伤:女性运动员相关问题的最新观点。

Relative Energy Deficiency in Sport (REDs) and knee injuries: current concepts for female athletes.

机构信息

Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119288, Singapore.

Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119288, Singapore.

出版信息

J ISAKOS. 2024 Aug;9(4):781-787. doi: 10.1016/j.jisako.2024.05.012. Epub 2024 May 23.

Abstract

In athletes, a mismatch between caloric intake and energy expended in exercise can eventually lead to Relative Energy Deficiency in Sport (REDs), where the athlete suffers from physiological derangements and decreased sport performance. The prevalence of REDs is higher in females than males. Females are already at a higher risk of knee injuries, which has been attributed to a multitude of factors such as hormonal influences, differences in musculoskeletal anatomy and neuromuscular control compared to males. The literature demonstrates an even higher risk of knee injuries in female athletes with symptoms of REDs. We propose the various factors that influence this risk. A reduction in anabolic hormones can affect muscle development and tendon repair. A relationship between poor neuromuscular control and knee injury has been established, and this can be further worsened in patients with menstrual dysfunction. Chronic deficiency in nutrients such as collagen and vitamin D can result in poorer recovery from microtrauma in tendons and ligaments. All these factors may contribute to increasing the risk of knee injuries, which may include anterior cruciate ligament tears, patella tendinopathy and patellofemoral pain syndrome. This review aims to educate sports clinicians to have a high index of suspicion when treating knee injuries in females; to screen and then manage for REDs if present, for holistic patient care.

摘要

在运动员中,如果热量摄入与运动所消耗的能量不匹配,最终可能导致运动性相对能量不足(REDs),使运动员出现生理紊乱和运动表现下降。女性 REDs 的患病率高于男性。女性已经面临更高的膝关节损伤风险,这归因于多种因素,如激素影响、与男性相比在肌肉骨骼解剖结构和神经肌肉控制方面的差异等。文献表明,有 REDs 症状的女性运动员膝关节损伤的风险更高。我们提出了影响这种风险的各种因素。合成代谢激素的减少会影响肌肉发育和肌腱修复。不良的神经肌肉控制与膝关节损伤之间存在关联,而在月经功能障碍的患者中,这种关联可能会进一步恶化。胶原蛋白和维生素 D 等营养物质的慢性缺乏会导致肌腱和韧带的微创伤恢复不佳。所有这些因素都可能增加膝关节损伤的风险,包括前交叉韧带撕裂、髌腱病和髌股疼痛综合征。本综述旨在教育运动临床医生在治疗女性膝关节损伤时要保持高度警惕;如果存在 REDs,则进行筛查和管理,以实现整体患者护理。

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