Background:

The incidence of contralateral anterior cruciate ligament (CACL) injuries after recovery from a first-time anterior cruciate ligament (ACL) disruption is high in women; however, little is known about the risk factors associated with this trauma.

Hypothesis:

Patient characteristics, strength, anatomic alignment, and neuromuscular characteristics of the contralateral uninjured leg at the time of the first ACL trauma are associated with risk of subsequent CACL injury, and these risk factors are distinct from those for a first-time ACL injury.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Sixty-one women who suffered a first-time noncontact ACL injury while participating in high school or college sports and underwent measurement of potential risk factors on their contralateral limb soon after the initial ACL injury and before reconstruction were followed until either a CACL injury or an ACL graft injury occurred, or until the last date of contact.

Results:

Follow-up information was available for 55 (90.0%) of the 61 athletes and 11 (20.0%) suffered a CACL injury. Younger age, decreased participation in sport before the first ACL disruption, decreased anterior stiffness of the contralateral knee, and increased hip anteversion were associated with increases in the risk of suffering a CACL injury.

Conclusion:

A portion of CACL injury risk factors were modifiable (time spent participating in sport and increasing anterior knee stiffness with bracing), while others were nonmodifiable (younger age and increased hip anteversion). The relationship between younger age at the time of an initial ACL injury and increased risk of subsequent CACL trauma may be explained by younger athletes having more years available to be exposed to at-risk activities compared with older athletes. A decrease of anterior stiffness of the knee is linked to decreased material properties and width of the ACL, and this may explain why some women are predisposed to bilateral ACL trauma while others only suffer the index injury. The risk factors for CACL injury are unique to women who suffer bilateral ACL trauma compared with those who suffer unilateral ACL trauma. This information is important for the identification of athletes who may benefit from risk reduction interventions.

中文翻译：

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高中和大学女运动员单侧前交叉韧带损伤后对侧膝关节非接触性前交叉韧带损伤相关的危险因素：一项前瞻性研究。

背景：

女性从首次前交叉韧带 (ACL) 断裂恢复后对侧前交叉韧带 (CACL) 损伤的发生率很高；然而，人们对与这种创伤相关的风险因素知之甚少。

假设：

第一次 ACL 损伤时对侧未受伤腿的患者特征、力量、解剖排列和神经肌肉特征与随后的 CACL 损伤风险相关，这些风险因素与首次 ACL 损伤的风险因素不同。

学习规划：

病例对照研究；证据水平，3。

方法：

对 61 名女性在参加高中或大学运动时首次非接触性 ACL 损伤，并在初次 ACL 损伤后和重建前不久接受对侧肢体潜在危险因素的测量，直至 CACL 损伤或发生 ACL 移植物损伤，或直到最后一次接触。

结果：

61 名运动员中有 55 名 (90.0%) 获得了随访信息，其中 11 名 (20.0%) 患有 CACL 损伤。年龄较小、第一次 ACL 断裂前运动参与减少、对侧膝关节前部僵硬降低和髋关节前倾增加与 CACL 损伤风险增加有关。

结论：

部分 CACL 损伤风险因素是可以改变的（参加运动的时间和使用支撑增加膝前部僵硬），而其他因素是不可改变的（年龄较小和髋关节前倾增加）。最初 ACL 损伤时的年龄较小与随后的 CACL 损伤风险增加之间的关系可能是因为与年长运动员相比，年轻运动员有更多年可从事高危活动。膝关节前部僵硬的降低与 ACL 的材料特性和宽度降低有关，这可以解释为什么一些女性易患双侧 ACL 损伤，而另一些女性则只遭受指数损伤。与单侧 ACL 外伤的女性相比，双侧 ACL 外伤的女性 CACL 损伤的危险因素是独一无二的。