Clinically Relevant Injury Patterns After an Anterior Cruciate Ligament Injury Provide Insight Into Injury Mechanisms
Clinically Relevant Injury Patterns After an Anterior Cruciate Ligament Injury Provide Insight Into Injury Mechanisms
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DOI：
10.1177/0363546512465167
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发表时间：
2013-02-01
影响因子：
4.8
通讯作者：
Demetropoulos, Constantine K.
中科院分区：
文献类型：
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作者：
Levine, Jason W.;Kiapour, Ata M.;Demetropoulos, Constantine K.
背景资料：前交叉韧带（ACL）损伤的功能障碍和高昂的治疗费用引起了人们对了解非接触性ACL损伤机制的极大兴趣。据报道，超过80%的部分和完全ACL断裂中存在继发性骨挫伤。目的：本研究的目的是（1）在一系列生理相关负荷条件下量化ACL应变，（2）评估与被认为是导致许多非接触性ACL损伤的负荷条件相关的软组织和骨损伤模式。研究设计：对照实验室研究。方法：使用定制设计的跌落支架对17条尸体腿（年龄，45 +/- 7岁; 9名女性和8名男性）进行了测试，以模拟着陆。将样本随机分配至2个载荷组，以评价膝关节外展或胫骨内旋力矩下的ACL应变。在每组中，在轴向冲击载荷下依次施加胫骨前剪切力、膝关节外展和胫骨内旋力矩的组合，直至失效。在模拟1200 N股四头肌和800 N腘绳肌载荷下，以25 °屈曲度对样本进行测试。使用差动可变磁阻传感器计算前内侧束的ACL应变。使用一般线性模型比较失效时的ACL峰值应变。结果：17例标本中有15例（88%）发生前交叉韧带损伤，损伤程度与载荷条件无关。观察到失效模式的临床相关分布，包括内侧副韧带撕裂和韧带、软骨和软骨下骨损伤。只有外展对计算的ACL峰值应变有显著贡献（P = .002）。虽然ACL破坏模式与载荷机制无关，但胫骨平台损伤模式（位置）显著（P = 0.002）取决于施加的载荷条件。损伤的关节软骨沿着与抑郁症的中外侧胫骨平台主要与膝关节外展moments，而软骨损伤与抑郁症的后外侧胫骨平台主要与内部胫骨rotation moments.Conclusion：目前的研究结果表明，胫骨平台损伤和ACL损伤机制的位置之间的关系。由此产生的损伤位置与非接触性ACL损伤期间临床观察到的胫骨平台上的骨瘀伤相似。这些研究结果表明，外展结合其他模式的负载（多平面负载）可能会产生ACL injuries.Clinical Relevance：更好地了解ACL损伤的机制和相关的风险因素可能会改善目前的预防，手术和康复策略，并限制ACL和继发性损伤的风险，这反过来又可能会尽量减少创伤后膝关节骨关节炎的未来发展。
Background: The functional disability and high costs of treating anterior cruciate ligament (ACL) injuries have generated a great deal of interest in understanding the mechanism of noncontact ACL injuries. Secondary bone bruises have been reported in over 80% of partial and complete ACL ruptures.Purpose: The objectives of this study were (1) to quantify ACL strain under a range of physiologically relevant loading conditions and (2) to evaluate soft tissue and bony injury patterns associated with applied loading conditions thought to be responsible for many noncontact ACL injuries.Study Design: Controlled laboratory study.Methods: Seventeen cadaveric legs (age, 45 +/- 7 years; 9 female and 8 male) were tested utilizing a custom-designed drop stand to simulate landing. Specimens were randomly assigned between 2 loading groups that evaluated ACL strain under either knee abduction or internal tibial rotation moments. In each group, combinations of anterior tibial shear force, and knee abduction and internal tibial rotation moments under axial impact loading were applied sequentially until failure. Specimens were tested at 25 degrees of flexion under simulated 1200-N quadriceps and 800-N hamstring loads. A differential variable reluctance transducer was used to calculate ACL strain across the anteromedial bundle. A general linear model was used to compare peak ACL strain at failure. Correlations between simulated knee injury patterns and loading conditions were evaluated by the chi(2) test for independence.Results: Anterior cruciate ligament failure was generated in 15 of 17 specimens (88%). A clinically relevant distribution of failure patterns was observed including medial collateral ligament tears and damage to the menisci, cartilage, and subchondral bone. Only abduction significantly contributed to calculated peak ACL strain at failure (P = .002). While ACL disruption patterns were independent of the loading mechanism, tibial plateau injury patterns (locations) were significantly (P = .002) dependent on the applied loading conditions. Damage to the articular cartilage along with depression of the midlateral tibial plateau was primarily associated with knee abduction moments, while cartilage damage with depression of the posterolateral tibial plateau was primarily associated with internal tibial rotation moments.Conclusion: The current findings demonstrate the relationship between the location of the tibial plateau injury and ACL injury mechanisms. The resultant injury locations were similar to the clinically observed bone bruises across the tibial plateau during a noncontact ACL injury. These findings indicate that abduction combined with other modes of loading (multiplanar loading) may act to produce ACL injuries.Clinical Relevance: A better understanding of ACL injury mechanisms and associated risk factors may improve current preventive, surgical, and rehabilitation strategies and limit the risk of ACL and secondary injuries, which may in turn minimize the future development of posttraumatic osteoarthritis of the knee.