A Case-Control Study of ACL Risk Factors

描述（由申请人提供）：前交叉韧带（ACL）损伤造成相当大的残疾，并使膝关节易发生早期骨关节炎。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越来越多，同时，前交叉韧带损伤也随之增加。前交叉韧带撕裂的发生率在女性中是男性的2至9倍；然而，关于人口统计学、损伤史、激素史、解剖学、神经肌肉和环境变量单独或共同影响前交叉韧带损伤风险的信息有限。大多数已知的风险因素研究都集中在孤立的选定变量上（例如股骨髁内切口宽度，a- p膝关节松弛度或月经周期），因此没有建立全面的前交叉韧带损伤风险模型并不奇怪。我们之前的研究表明，女性与男性的前交叉韧带损伤风险模型可能不同，这也是我们研究的原因，目的是找到识别女性和男性前交叉韧带损伤风险增加的独特风险因素组合。我们研究的假设是：结合人口统计学、损伤史、激素史、解剖学、神经肌肉和环境变量可用于识别非接触性前交叉韧带损伤风险增加的女性，并且这些变量的单独组合可用于识别前交叉韧带损伤风险增加的男性。首先，我们将确定审查员能够以可靠的方式测量潜在的风险因素。我们将召集一群大学和大学预科的运动员，并跟踪他们前瞻性的前交叉韧带损伤病例。然后，我们将进行一项嵌套病例对照研究，以确定前交叉韧带损伤的危险因素。对于每个受伤案例，将从受伤时或之前未受伤的队友中选择三个控制组。对于前交叉韧带撕裂的受试者，未因损伤而改变的潜在危险因素将从受伤肢体测量，而被损伤改变的潜在危险因素将从对侧、正常肢体测量，并用于表示ACL缺陷肢体损伤前的状况。在匹配的对照上获得相同的测量结果。这项研究具有重要意义，因为它将确定假定的风险因素，确定女性和男性ACL损伤风险增加，并允许未来的干预研究减少这种使人衰弱的损伤的发生率。

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.