A Case-Control Study of ACL Risk Factors

描述(由申请人提供)：前十字韧带(ACL)损伤会造成相当大的残疾，并使膝盖容易过早发生骨关节炎。这是一个令人担忧的问题，因为在过去的20年里，女性参与体育运动的人数有所增加，随之而来的是前交叉韧带损伤的增加。女性前交叉韧带撕裂的发生率是男性的2-9倍；然而，关于单独或共同导致前交叉韧带损伤风险的人口统计学、伤害史、激素史、解剖学、神经肌肉和环境变量的信息有限。已知的大多数研究都来自于风险因素研究，这些研究集中于孤立地选择变量(例如股骨内髁间切迹宽度、A-P膝关节松弛或月经周期)，因此，没有建立全面的前交叉韧带损伤风险模型也就不足为奇了。我们先前的研究表明，与男性相比，女性前交叉韧带损伤的风险模型可能不同，这也是我们调查的依据，其目的是找到独特的危险因素组合，识别出女性和男性遭受前交叉韧带损伤风险增加的风险。我们研究的假设是：人口统计学、伤害史、激素史、解剖学、神经肌肉和环境变量的组合可以用来识别非接触性前交叉韧带损伤风险增加的女性，而这些变量的单独组合可以用来识别前交叉韧带损伤风险增加的男性。最初，我们将确定主考员可以可靠地测量潜在的风险因素。我们将召集一批大学和大学之前的运动员，跟踪他们，以期增加前交叉韧带损伤的病例。然后，我们将进行嵌套式病例对照研究，以确定前交叉韧带损伤的危险因素。每个受伤案例的三个对照将在受伤时从当时或之前没有受伤的队友中选择。对于遭受前交叉韧带撕裂的受试者，未被损伤修改的潜在危险因素将从受伤的肢体测量，而被损伤修改的因素将从对侧正常肢体测量，并用于表示前交叉韧带缺陷肢体的损伤前状况。在匹配的对照组上将获得相同的测量结果。这项研究意义重大，因为它将确定可能的危险因素，确定增加前交叉韧带损伤风险的女性和男性，并允许未来的干预研究减少这种衰弱损伤的发生率。

DESCRIPTION (provided by applicant): Anterior cruciate ligament (ACL) injury creates considerable disability and predisposes the knee to the early onset of osteoarthritis. This is a concern because the past two decades has seen an increased participation of women in sports and with this has come a concomitant increase in ACL injuries. The incidence rate of ACL tears is 2 to 9 times greater amongst females in comparison to males; however, there is limited information with regard to the demographic, injury history, hormonal history, anatomic, neuromuscular, and environmental variables that individually or collectively contribute to the risk of suffering an ACL injury. Most of what is known has come from risk factor studies that have focused on selected variables in isolation (e.g. femoral intra-condylar notch width, A-P knee laxity, or phase of menstrual cycle) and consequently it is not surprising that a comprehensive ACL injury risk model has not been established. Our prior research has revealed that the risk model for ACL injury is probably different for females compared to males and this serves as the rational for our investigation, the objective of which is to find the unique combination of risk factors that identify females and males at increased risk of suffering an ACL injury. The hypothesis of our study is: A combination of demographic, injury history, hormonal history, anatomic, neuromuscular, and environmental variables can be used to identify females at increased risk of non-contact ACL trauma, and that a separate combination of these variables can be used to identify males at increased risk of ACL trauma. Initially, we will establish that examiners can measure the potential risk factors in a reliable manner. We will assemble a cohort of collegiate and pre-collegiate athletes and follow them to prospectively accrue ACL injury cases. We will then perform a nested case-control study to identify risk factors for ACL injury. Three controls for each injury case will selected at the time of injury from among teammates who have not been injured at or prior to that time. For subjects that suffer an ACL tear, the potential risk factors that are not modified by the injury will be measured from the injured limb while the factors that are modified by the injury will be measured from the contra-lateral, normal, limb and used to represent the pre-injury condition of the ACL-deficient limb. The same measurements will be obtained on the matched controls. This investigation is significant because it will determine the putative risk factors that identify females and males at increased risk for ACL injury and allow future intervention studies that reduce the incidence of this debilitating injury.