알파인 스키선수의 전방십자인대 손상 메케니즘: 단일사례연구

임비오(BeeOhLim),양우영(WooYoungYang),최범권(BumKwonChoi) 한국체육학회 2013 한국체육학회지 Vol.52 No.6

알파인 스키선수들은 전방십자인대 부상을 많이 입는데, 그 원인에 대한 연구는 미비한 실정이다. 본 연구의 목적은 알파인 스키 활주 중에 발생한 실제 비접촉성 전방십자인대 손상 장면을 담은 비디오 분석을 통하여 전방십자인대손상 메케니즘을 규명하는 것이다. 실제 알파인 스키 중에 전방십자인대 부상을 입은 비디오 한 건을 입수하여, 부상상황, 스키 선수의 행동, 생체역학적 특성 등과 같은 부상 원인을 분석하였다. 연구결과, 시즌 말에 슬로프 상태가 나쁜 상황에서 부상이 발생하였다. 부상 당시 스키 선수는 젖은 슬로프로 인해 스키 플레이트보다 몸이 앞쪽과 안쪽으로 기울어졌으며, 이 때 균형을 잃었다. 스키 플레이트의 아웃사이드 엣지가 눈에 걸려서 왼쪽 무릎이 안굽이되고 가쪽 돌림이 발생하였고, 스키 선수는 왼편의 안쪽으로 넘어졌다. 그 힘으로 인해 전방십자인대가 파열되었다. 결론적으로 지금까지 밝혀진 부츠-유발 앞쪽 당김 메케니즘과 유령발 메케니즘과는 다른, 활주 속도와 중심 이동 동작의 불균형이 일어나서 아웃사이드 엣지의 그립으로 인한 안굽이-가쪽 돌림 메케니즘이 새롭게 규명되었다. The anterior cruciate ligament has been shown to be particularly susceptible to injury during alpine skiing. But, there is limited insight into the mechanisms of anterior cruciate ligament injuries in alpine skiing. The purpose of this study was to investigate the mechanisms of anterior cruciate ligament injury in alpine skiing. A single case of anterior cruciate ligament injury were obtained on video and analyze the injury mechanism in detail(skiing situation, skier behavior, biomechanical characteristics). The injury occurred in bad slope condition of late season. The skier move forward relative to the ski due to the wet slope condition and out of balance forward and inward in the steering phase into the fall line. The inner ski catches the outside edge abruptly, forcing the left knee into varus and external rotation and the skier falls inward to her left. As a result, the forces generated rupture the anterior cruciate ligament. Based on this video analysis, the new mechanism of anterior cruciate ligament injury in alpine skiing appeared to be a catching by incorrect crossover situation where the inner ski catches the outside edge, forcing the inner knee into varus and external rotation.

Ligament Reconstruction in Congenital Absence of the Anterior Cruciate Ligament: A Case Report

( Jae Jeong Lee ),( Won Taek Oh ),( Keun Young Shin ),( Min Seok Ko ),( Chong Hyuk Choi ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.4

Congenital absence of the cruciate ligament is an extremely rare condition that was fi rst reported in Giorgi`s radiographic study in 1956. The authors report on a case of anterior cruciate ligament reconstruction performed on a 21-year-old female patient with congenital anterior cruciate ligament absence. We also discuss radiographic evidence that could provide clues to the congenital absence and possible diffi culties that may be encountered during surgery with a review of the relevant literature.

전방십자인대의 해부학

정영복,염재광,Jung, Young-Bok,Yum, Jae-Kwang 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

The anterior cruciate ligament(ACL) is, perhaps, the most intriguing component of the knee joint. Initially referred to crucial ligament because of the cruciate or crossed arrangement or the anterior and posterior ligaments within the knee. the irony or the ACL being crucial to the well-being or the joint has only recently appreciated. The anterior cruciate ligament of human knee joint is a complex structure and its orientation, construct and biology arc directly related to the knee function as a constraint of knee joint motion. In addition to its functional role as a static stabilizer or the knee. the ACL has a unique neurovascular system. The vascular anatomy of the ACL plays a crucial role in the repair and reconstruction of the ligament, and the neuroreceptors found in its substance suggest a possible proprioceptive role for the ligament. The structural complexity of the ACL allows the ligament to function through the normal range of motion as a static stabilizer or the knee. hut it also makes the exact duplication of this structure very difficult. A comprehensive knowledge or the anatomy of the ACL can provide the orthopedic surgeon with a blueprint for the idealized repair and reconstruction of this most complex structure.

Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta-analysis

( Diego Ariel De Lima ),( Lana Lacerda De Lima ),( Nayara Gomes Reis De Souza ),( Rodrigo Amorim De Moraes Perez ),( Marcel Faraco Sobrado ),( Tales Mollica Guimaraes ),( Camilo Partezani Helito ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Objectives: To compare the clinical outcomes of isolated anterior cruciate ligament (ACL) reconstruction with combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. Methods: A search was conducted on the PubMed, Medline, Google Scholar, EMBASE, and Cochrane library databases, in line with the PRISMA protocol. The indexation terms used were “anterior cruciate ligament” OR “acl” AND “anterolateral ligament” AND “reconstruction.” Articles that compared patients submitted to combined ACL and ALL reconstruction with those submitted to isolated reconstruction of the ACL, with levels of evidence I, II, and III, were included. Studies with follow-up of less than 2 years and articles that did not use “anatomical” techniques for ALL reconstruction, such as extraarticular tenodesis, were excluded. A meta-analysis with R software was conducted, with a random effects model, presented as risk ratio (RR) or mean difference (MD), with a 95% confidence level (CI) and statistically significant at p < 0.05. Results: Ten articles were selected, with a total of 1495 patients, most of whom were men, of whom 674 submitted to ACL and ALL reconstruction and 821 to isolated ACL reconstruction. Combined ACL and ALL reconstruction exhibited a statistically significant advantage in residual pivot shift (RR 0.34, 95% CI 0.24-0.47, I² = 0%, p < 0.01), rerupture rate (RR 0.34, 95% CI 0.19-0.62, I² = 0%, p < 0.01), Lachman test (RR 0.59, 95% CI 0.40-0.86, I² = 21%, p < 0.01), and postoperative Lysholm score (MD 2.28, CI 95% 0.75-3.81, I² = 73%, p < 0.01). Conclusions: Combined ACL and ALL reconstruction obtained better postoperative clinical outcomes when compared with isolated ACL reconstruction, especially in reducing residual pivot shift and rerupture rate.

Management of mucoid degeneration of the anterior cruciate ligament: a systematic review

( Tamer Sweed ),( Mohamed Mussa ),( Ahmed El-bakoury ),( Guido Geutjens ),( Andrew Metcalfe ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Purpose: The purpose of this study was to investigate the outcomes of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported. Methods: A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: A total of nine studies were eligible for review. All nine studies assessed the outcome of arthroscopic debridement of MDACL. A total of 313 knees in 292 patients were included. The mean follow up ranged from 13 to 72 months. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). The rate of simultaneous meniscectomy ranged from 13 to 44%. Postoperative pain relief ranged from 53.8 to 95%. There was an improvement in postoperative range of motion and outcome scores (Lysholm and International Knee Documentation Committee scores and the Knee Injury and Osteoarthritis Outcome Score). Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. The mean MINORS score was 9.5 out of 16 (4-12). Conclusions: Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed. Level of evidence: IV

전방십자인대의 기능성 보조기: 체계적 문헌고찰

김두한,이동원,김진구 대한스포츠의학회 2018 대한스포츠의학회지 Vol.36 No.2

Functional knee braces are commonly prescribed to support anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the current literature on the use of functional knee braces of ACL with respect to biomechanical, clinical and functional outcomes. A literature search was conducted (2000 to 2017) by two independent reviewers using PubMed MEDLINE database. Articles were retrieved by an electronic search using keywords (anterior cruciate ligament, brace, and bracing) and their combinations. Current functional braces used to treat ACL injury were identified. Studies that met inclusion criteria were assessed for pertinent data. Fourteen studies met the inclusion criteria. Functional knee brace reportedly did not improve long-term clinical and functional outcomes following ACL reconstruction, but some studies suggest that functional brace may have some benefit with regard to biomechanics, proprioception, and subsequent injury rates. Functional knee brace after ACL reconstruction was found no significant difference in clinical and functional outcomes. But Further large-scale recent studies will be required to determine long-term outcomes of the brace.

The mechanism and cause of anterior cruciate ligament tear in the Korean military environment

( Joosuk Ahn ),( Byungseop Choi ),( Yong Seuk Lee ),( Ki Woung Lee ),( Jung Woo Lee ),( Beom Koo Lee ) 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.1

Purpose: Anterior cruciate ligament (ACL) injury is very common but few studies have analyzed the injury mechanism and cause of ACL tear in a specific environment such as a military institution. The purpose of this study was to analyze the injury mechanism and cause of ACL injury in the military environment. Additionally, this study could provide outcomes that may aid future studies on prevention of ACL injury in military personnel. Materials and methods: This study retrospectively analyzed 168 patients who sustained ACL tear while in military service and underwent ACL reconstruction surgery in a military hospital. Analysis of the injury mechanism and the cause was evaluated by analyzing the medical records. Knee magnetic resonance imaging analysis was also conducted for further evaluation of associated injury. Results: The majority of ACL injuries in the military environment occurred through non-contact injury. Changing direction (46.4%) was the most common lower-leg position, followed by landing with the knee in a valgus position (26.8%). The activity undertaken at the time of injury was exercise in 76.2% of cases and military training/daily activities in 23.8% of cases. The incidence of ACL injury was higher in the soldier compared to the officer group during exercise (P = 0.017). Soccer was the most common activity at the time of injury (54.1%), followed by military training/daily activities, futsal, and basketball. The most common injury time was between 30 and 60 min after the start of exercise. Commonly associated injury sites were the medial meniscus and the medial collateral ligament. Conclusions: The main mechanism of ACL injury occurring in the military environment was non-contact injury, especially on changing the direction of the lower leg. Soccer was the most frequent activity at the time of the injury. These findings suggested that preventive strategies against ACL injury in the military environment could effectively reduce the incidence of ACL injury.

New insights in anterior cruciate ligament morphology: implications for anterior cruciate ligament reconstruction surgeries

Rekha Lalwani,Rohit Srivastava,Sheetal Kotgirwar,Sunita A. Athavale 대한해부학회 2020 Anatomy & Cell Biology Vol.53 No.4

The frequency of injury of anterior cruciate ligament (ACL), the importance of anatomy in surgical repair and potential of the injured ACL to predispose to osteoarthritis necessitates the need for understanding its precise anatomy. Available studies have focussed on tunnel positioning and hence attachment site of the ligament. Few studies which have focussed on morphology reflect ambiguities in size, fibre bundle, number and disposition. Since a near anatomical repair of the ACL is the treatment of choice, the present study was planned to describe the morphology of ACL. Twenty-two ACL (11 right and 11 left) isolated from knee joints of collection of adult embalmed lower limbs were utilised for the study. The ACL morphology and morphometry were studied for footprints and fibre bundles. Three distinct bundles of differing lengths constitute a spiral ACL complex. These bundles are positioned as- intermediate with posteromedial and anterolateral flanking in respective positions. The tibial and femoral footprints are paw-shaped and oval respectively. Tibial footprints are approximately 2.5 times larger in area than the femoral footprints. The unique morphology of ACL vis a vis its spiralization, and its mechanical advantage of in terminal extension and conjunct rotation of knee (which are peculiarly human trait) are discussed. It is recommended to utilize the concept of spiralization and differing bundle length in ACL surgeries to achieve the favourable clinical outcome.

Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew

Doo-Sup Kim,Chang-Ho Yi,Hoi-Jung Chung,Yeu-Seung Yoon 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.4

Background: Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restorethe native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstructionand to evaluate the clinical outcome. Methods: Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft withoutdetachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fi xation was done by hybrid fi xation using Endobutton and Rigidfi x for AMB and by biointerference screw for PLB. Tibialfi xations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independentlyand differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participatedin this study. The patients were followed up with clinical examination, Lysholm scales and International Knee DocumentationCommittee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. Results: Signifi cant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Onlyone of participants had fl exion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvementfrom average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. AverageLysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and signifi cant improvement was seen, score was92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormalin 1 case at last follow-up. Conclusions: Our new double bundle ACL reconstruction technique used hybrid fi xation and Retroscrew had favorable outcomes.

Lack of Correlation between Dynamic Balance and Hamstring-to-Quadriceps Ratio in Patients with Chronic Anterior Cruciate Ligament Tears

( Dae Hee Lee ),( Jin Hyuck Lee ),( Hye Jin Jeong ),( Seok Joo Lee ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.2

Purpose: The purpose of this study was to evaluate the quadriceps and hamstring muscle strength and hamstring-to-quadriceps (HQ) ratio, as well as the relationships of these parameters with dynamic balance, in patients with anterior cruciate ligament (ACL) rupture. Materials and Methods: We compared 25 patients diagnosed with chronic unilateral ACL tears and 25 age-matched healthy volunteers. The maximal torque of the quadriceps and hamstring and dynamic balance were measured. Results: Although the isokinetic maximal peak torques were about 50% lower in the quadriceps (57%, p<0.001) and hamstring (56%, p=0.001) muscles in the chronic ACL tear group than in the control group, their HQ ratios were similar (56%±17% vs. 58%±6%, p=0.591). HQ ratio was significantly correlated with anterior-posterior stability index (r=-0.511, p=0.021) and overall stability index (r=-0.476, p=0.034) in control group, but these correlations were not observed in chronic ACL tear group. Conclusions: Thigh muscle strength was about 50% lower in the chronic ACL tear group than in the control group, but the HQ ratio was similar. The dynamic balance of the knee was not influenced by thigh muscle strength but was influenced by HQ ratio in healthy young individuals. However, HQ ratio was not correlated with dynamic knee balance in chronic ACL tear patients.