The ACL Injury Enigma: We Can't Prevent What We Don't Understand

摘要: M ultiple risk factors, both modifiable and nonmodifiable, are known to manifest within the noncontact anterior cruciate ligament (ACL) injury mechanism.1 I will primarily address neuromechanical contributions risk, which often a key focus at meetings of this nature; such factors amenable training and, hence, largely modifiable. hope, however, that as reader progresses through document, critical importance underlying nonmodifiable resultant strategy not be lost. Sexual dimorphism in neuromuscular linked ACL is well documented, with ‘‘female’’ movement pattern interpreted riskier. Females, for example, land more extended posture,2 quadriceps dominant,1–3 demonstrate altered muscle activation coactivation4 greater out-of-plane knee motions5 loads6–9 than males. Neuromuscular strategies continue evolve line these findings represent an ever-increasing equally important research focus.10–12 Recent epidemiologic data, suggest spite ongoing initiatives reported early successes,13,14 rates associated sex disparity have diminished.15 If current prevention methods delivered reasonable efficacy, one would assume noticeable reduction already evident. It appears, therefore, fail counter implicated mechanism. In particular, understanding precise control biomechanics mechanism their integration structural hormonal remains limited. The lack insight into thus, how they can effectively countered appears arise several factors. remainder paper on some hope researchers mechanisms begin them. Currently, potential predictors generated from laboratory-based assessment ‘‘safe’’ tasks. Although much gained evaluating high-risk sport postures controlled laboratory setting, inferring assessments questionable. Hence, brings together field environments warranted. Sports injuries common governed by random complex series dynamic events, requiring complex, centrally coordinated response.16,17 Integrating sport-relevant vivo experimental testing environment may, provide further crucial insights causal injury, facilitating development effective adaptable methods. Authors recent studies begun acknowledge fact regularly incorporating design fatiguing8,18,19 decision-making20–22 tasks, inherent realistic participation. Because each promotes substantial adaptation profile exaggerates variables considered high including them when assessing critical. Further, data combined effect tasks may worst-case scenario terms compromise spinal specifically, supraspinal ineffective decision, response, strategies.16 Along increasing efforts develop environments, similar groundswell bringing field. Such developments only permit biomechanical during actual scenarios but also contribute substantially screening ultimately, diminution or elimination Model-based image-matching techniques, using commercially available software applications, estimate joint kinematics accuracy videos events.23 Combining measures obtained movements setting helpful injury. Other developments, markerless motion capture techniques24 wearable sensors,25 similarly allow lower limb mechanics participation possibly, true scenarios. These devices excellent method high-risk, profiles further, countering dynamic, real-time feedback techniques. possibilities alone additional exploration Current modeling methods, while obviously representing on-field assessment, afford extension beyond vivo, Journal Athletic Training 2008;43(5):538–540 g National Trainers’ Association, Inc www.nata.org/jat summary