What Strains the Anterior Cruciate Ligament During a Pivot Landing?
What Strains the Anterior Cruciate Ligament During a Pivot Landing?
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DOI：
10.1177/0363546511432544
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发表时间：
2012-03-01
影响因子：
4.8
通讯作者：
Wojtys, Edward M.
中科院分区：
文献类型：
--
作者：
Oh, Youkeun K.;Lipps, David B.;Wojtys, Edward M.
背景资料：轴向胫骨扭矩和额状面力矩对枢轴着陆时前交叉韧带（ACL）应变的相对贡献是未知的。假设：ACL前内侧（AM）束的峰值归一化相对应变受轴向胫骨扭矩方向的影响，但不受模拟跳跃着陆时同时施加的额状面力矩方向的影响。研究设计：对照和描述性实验室研究：方法：15个成年男性膝关节与预张膝关节肌肉肌腱单位的力量进行了加载下模拟枢轴着陆测试。在记录3D膝关节载荷和胫股运动学的同时，对胫骨远端同时施加压缩、屈曲力矩、内部或外部胫骨扭矩以及膝关节内翻或外翻力矩。AM-ACL相对应变使用3 mm差分可变磁阻传感器测量。使用非参数Wilcoxon符号秩检验分析结果。使用亚当斯开发了一个三维动态生物力学膝关节模型，并进行了验证，以帮助解释实验结果。平均（SD）峰值AM-ACL相对应变比对照组高192%，（P < .001）在胫骨内扭矩和膝关节内翻或外翻力矩的组合下（分别为7.0% [3.9%]和7.0% [4.1%]），而在相同力矩的情况下，在胫骨外扭矩下（分别为2.4% [2.5%]和2.4% [3.2%]）。膝关节外翻力矩增加了AM-ACL应变，由于胫骨平台诱导机械耦合（即，内部胫骨旋转和膝关节外翻力矩）的斜率;这种增强发生在内侧膝关节间隙opening.Conclusion：内部胫骨扭矩结合膝关节外翻力矩是最坏情况下的ACL加载条件。然而，它是主要导致大ACL strain.Clinical Relevance的内部胫骨扭矩：限制鞋和比赛表面之间的最大摩擦系数应限制峰值内部胫骨扭矩，可以施加到膝关节在跳跃着陆，从而减少峰值ACL应变和非接触性损伤的风险。
Background: The relative contributions of an axial tibial torque and frontal plane moment to anterior cruciate ligament (ACL) strain during pivot landings are unknown.Hypothesis: The peak normalized relative strain in the anteromedial (AM) bundle of the ACL is affected by the direction of the axial tibial torque but not by the direction of the frontal plane moment applied concurrently during a simulated jump landing.Study Design: Controlled and descriptive laboratory studies.Methods: Fifteen adult male knees with pretensioned knee muscle-tendon unit forces were loaded under a simulated pivot landing test. Compression, flexion moment, internal or external tibial torque, and knee varus or valgus moment were simultaneously applied to the distal tibia while recording the 3D knee loads and tibiofemoral kinematics. The AM-ACL relative strain was measured using a 3-mm differential variable reluctance transducer. The results were analyzed using nonparametric Wilcoxon signed-rank tests. A 3D dynamic biomechanical knee model was developed using ADAMS and validated to help interpret the experimental results.Results: The mean (SD) peak AM-ACL relative strain was 192% greater (P < .001) under the internal tibial torque combined with a knee varus or valgus moment (7.0% [3.9%] and 7.0% [4.1%], respectively) than under external tibial torque with the same moments (2.4% [2.5%] and 2.4% [3.2%], respectively). The knee valgus moment augmented the AM-ACL strain due to the slope of the tibial plateau inducing mechanical coupling (ie, internal tibial rotation and knee valgus moment); this augmentation occurred before medial knee joint space opening.Conclusion: An internal tibial torque combined with a knee valgus moment is the worst-case ACL loading condition. However, it is the internal tibial torque that primarily causes large ACL strain.Clinical Relevance: Limiting the maximum coefficient of friction between the shoe and playing surface should limit the peak internal tibial torque that can be applied to the knee during jump landings, thereby reducing peak ACL strain and the risk for noncontact injury.