两例青春期女性继发性非接触性前交叉韧带损伤的三维生物力学分析：同侧ACL再断裂与对侧ACL断裂的病例系列研究
简介
本病例系列报告了两例青少年女性二次非接触性ACL损伤（同侧ACL再断裂及对侧ACL断裂）的三维生物力学特征，损伤均发生在重返运动测试中的非计划90°急停变向动作时。结果显示，快速接近且末步减速不足、触地距离过大、下肢过度前伸或外展并伴身体转向，可能限制膝关节屈曲，导致膝关节承受较大负荷。该发现提示康复训练应针对减少上述高风险动作模式，以降低二次ACL损伤风险…
英文摘要
Anterior cruciate ligament (ACL) ruptures are significant knee injuries. Many studies have analysed video footage of the mechanisms of injury; however, the three-dimensional biomechanics of ACL ruptures have not previously been captured and presented. This case series reports on two secondary non-contact ACL ruptures in adolescent females: one ipsilateral ACL re-rupture and one contralateral ACL rupture. The injuries occurred during unplanned 90° cuts, which were completed as part of the clinic's standard of care return-to-play testing. Spatiotemporal parameters, joint and segment kinematics, ground reaction forces and joint moments and forces are presented during the approach, at the penultimate step and initial contact, and during the stance phase of the cutting step. These biomechanics are compared to planned 90° cuts and a pre-injury unplanned 90° cut. While there were slight differences in the exact injury mechanisms, common factors appeared to have contributed to the ACL ruptures. These potential mechanisms of injury included a fast approach speed without sufficient deceleration at the penultimate step; a larger touchdown distance; and a more outstretched leg in the anterior or lateral direction which, when combined with the rotation of the body towards the direction of the cut, may have limited knee flexion which likely contributed to large forces and moments acting at the knee. This case series highlights the need to develop training strategies aimed at reducing risky movement behaviours to reduce the risk of subsequent non-contact ACL injuries.