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，并使膝关节易于早期发生骨关节炎。这是一个令人关切的问题，因为在过去的二十年里，妇女参加体育运动的人数有所增加，随之而来的是ACL损伤的增加。女性ACL撕裂的发生率是男性的2 - 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的信息有限，这些变量单独或共同导致ACL损伤的风险。已知的大多数来自风险因素研究，这些研究集中于孤立的选定变量（例如股骨髁内窝宽度、前后膝关节松弛或月经周期的阶段），因此，尚未建立全面的ACL损伤风险模型也就不足为奇了。我们之前的研究表明，女性ACL损伤的风险模型可能与男性不同，这是我们调查的理由，其目的是找到识别女性和男性ACL损伤风险增加的风险因素的独特组合。我们研究的假设是：人口统计学、损伤史、激素史、解剖学、神经肌肉和环境变量的组合可用于识别非接触性ACL创伤风险增加的女性，这些变量的单独组合可用于识别ACL创伤风险增加的男性。首先，我们将确定检查人员能够以可靠的方式测量潜在的风险因素。我们将召集一组大学生和大学预科运动员，并跟踪他们前瞻性地累积ACL损伤病例。然后，我们将进行巢式病例对照研究，以确定ACL损伤的危险因素。在受伤时，将从当时或之前没有受伤的队友中为每个受伤病例选择三个对照。对于遭受ACL撕裂的受试者，将从受伤肢体测量未被损伤改变的潜在风险因素，而将从对侧正常肢体测量被损伤改变的因素，并用于代表ACL缺陷肢体的损伤前状况。将在匹配对照品上获得相同的测量值。这项研究意义重大，因为它将确定公认的风险因素，确定女性和男性ACL损伤的风险增加，并允许未来的干预研究，减少这种衰弱性损伤的发生率。

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.