앞십자인대 손상 예방을 위한 근신경 훈련의 최신 경향: 문헌 고찰

이광진 ( Kwang-jin Lee ),안근옥 ( Keun-ok An ) 한국운동생리학회 2021 운동과학 Vol.30 No.4

PURPOSE: Anterior cruciate ligament (ACL) injuries are the most common in sports and have doubled in the past 20 years. This study aimed to analyze the latest trends and changes in training programs for ACL injury prevention. METHODS: In this study, literature was searched using academic search sites, such as ‘PubMed’, ‘Google Scholar’, and ‘Wiley Online Library’. The literature published between 2015 and 2021 was used. RESULTS: Eleven papers were selected based on the literature selection criteria. Five warm-up exercise papers and six ACL injury prevention training program papers emphasized neuromuscular training. CONCLUSIONS: The ACL injury prevention program can be applied in warm-up exercises and training programs. It consists of an exercise form that includes multidimensional components such as plyometrics, muscle strength, balance, and agility. The key to the ACL injury prevention program is to reflect multidimensional components in neuromuscular training and to obtain a significant effect, and it is recommended to participate in regular training for 12-18 sessions and at least 6 months. In addition, it is suggested to utilize the ACL injury prevention program presented in this study until an individual study for ACL injury prevention by sports type is conducted.

Is it worth to perform initial non-operative treatment for patients with acute ACL injury?: a prospective cohort prognostic study

( Yong-geun Park ),( Chul-won Ha ),( Yong-beom Park ),( Sang-eun Na ),( Manyoung Kim ),( Tae Seon Kim ),( Yong Yeon Chu ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Purpose: To evaluate the result of implementing an initial non-operative treatment program for an acute ACL injury and to find if the timing of initiating the non-operative treatment is significant. Methods: This study included a prospective cohort of 85 consecutive patients with acute ACL injury who were treated according to the above strategy for the initial 3 months with 1-year follow-up. Clinical evaluations were made by Lysholm score, Tegner activity score, Lachman test (LT), pivot-shit test (PST), and the side to side difference (SSD) by KT-2000 arthrometer. The results were analyzed according to the timing of initiating the nonoperative treatment. Results: Initially, 84% of the patients showed LT and PST ≤ grade 1, and 16% with ≥grade 2. At 1-year follow-up, 77 patients (91%) with LT and PST ≤ grade 1 did not receive reconstruction as copers and 8 patients with LT or PST ≥ grade 2 required reconstruction (six patients received the operation and two refused). The patients with LT and PST ≤ grade 1 showed average Lysholm score 91.2, average SSD 2.5 mm, and mean Tegner score decreased from 6.9 (pre-injury) to 6.2. Patients who started the non-operative treatment within 2 weeks after injury revealed superior rates of grade 0 or 1 instability than those who commenced the treatment later than 2 weeks after injury (P = 0.043). Conclusions: Implementing a non-operative treatment with brace in acute phase of ACL injury appears to be an effective and viable option to achieve a reasonable clinical outcome. We recommend earlier initiation of the nonoperative treatment to obtain a better result in patients with acute ACL injury.

스키에 의한 전방십자인대 손상에 대한 고찰

박주환,전성화,양난희,김용권,김지혁,Park, Ju-Hwan,Jun, Sung-Hwa,Yang, Nan-Hea,Kim, Yong-Kwon,Kim, Chi-Hyuk 대한물리치료과학회 2003 대한물리치료과학회지 Vol.10 No.1

The ACL(Anterior cruciate ligament) is the smallest of the four main ligaments of the knee, but it is the primary stabilizer. Injuries have a tendency to occur when the foot is firmly planted and the knee is twisted. Any sports that requires acceleration, change of direction and deceleration can increase the chances of suffering an ACL tear. The incidence of severe knee sprains that involve the ACL are at an all-time high. Since 1980, the number of these injuries have increased at least three-fold. Although the rate of increase has been much less dramatic since the middle 1980s, even the ultra-modem releasable ski binding has not been able to start reducing the incidence of ACL injuries. An ACL injury prevention program developed for downhill skiers by the Vermont Safety Research group emphasized increasing awareness of situations that can potentially result in an ACL injury and pre-planning strategies if events, leading to these situations, begin to fall in place. As part of the above study by Ettlinger et al., an educational prevent program was developed to teach these principles and thus reduce the rate of serious knee injuries. Four thousand instructors and patrol at 20 ski resorts who received the training had a 62% decline in serious knee injuries compared to a similar group that did not receive this training. Whenever you fall, try not to fully straighten your legs. Don't try to get up until you've stopped sliding(unless you are try to avoid an obstacle or other skier). When you're down, stay down. And don't land on your hand. So, if you feel yourself falling: arms forward, ski plates together, hands over knee. Then you will be able to save your ACL.

Effects of Sports Injury Prevention Training on the Biomechanical Risk Factors of Anterior Cruciate Ligament Injury in High School Female Basketball Players

Lim, Bee-Oh,Yong Seuk Lee,,Jin Goo Kim,,Keun Ok An,,Jin Yoo,,Young Hoo Kwon, SAGE Publications 2009 AMERICAN JOURNAL OF SPORTS MEDICINE - Vol.37 No.9

<P><B>Background:</B> Female athletes have a higher risk of anterior cruciate ligament injury than their male counterparts who play at similar levels in sports involving pivoting and landing.</P> <P><B>Hypothesis:</B> The competitive female basketball players who participated in a sports injury prevention training program would show better muscle strength and flexibility and improved biomechanical properties associated with anterior cruciate ligament injury than during the pretraining period and than posttraining parameters in a control group.</P> <P><B>Study Design:</B> Controlled laboratory study.</P> <P><B>Methods:</B> A total of 22 high school female basketball players were recruited and randomly divided into 2 groups (the experimental group and the control group, 11 participants each). The experimental group was instructed in the 6 parts of the sports injury prevention training program and performed it during the first 20 minutes of team practice for the next 8 weeks, while the control group performed their regular training program. Both groups were tested with a rebound-jump task before and after the 8-week period. A total of 21 reflective markers were placed in preassigned positions. In this controlled laboratory study, a 2-way analysis of variance (2 × 2) experimental design was used for the statistical analysis (<I>P</I> < .05) using the experimental group and a testing session as within and between factors, respectively. Post hoc tests with Sidak correction were used when significant factor effects and/or interactions were observed.</P> <P><B>Results:</B> A comparison of the experimental group’s pretraining and posttraining results identified training effects on all strength parameters (<I>P</I> = .004 to .043) and on knee flexion, which reflects increased flexibility (<I>P</I> = .022). The experimental group showed higher knee flexion angles (<I>P</I> = .024), greater interknee distances (<I>P</I> = .004), lower hamstring-quadriceps ratios (<I> P</I> = .023), and lower maximum knee extension torques (<I>P</I> = .043) after training. In the control group, no statistical differences were observed between pretraining and posttraining findings (<I>P</I> = .084 to .873). At pretraining, no significant differences were observed between the 2 groups for any parameter (<I>P</I> = .067 to .784). However, a comparison of the 2 groups after training revealed that the experimental group had significantly higher knee flexion angles (<I>P</I> = .023), greater knee distances (<I> P</I> = .005), lower hamstring-quadriceps ratios (<I>P</I> = .021), lower maximum knee extension torques (<I>P</I> = .124), and higher maximum knee abduction torques (<I>P</I> = .043) than the control group.</P> <P><B>Conclusion:</B> The sports injury prevention training program improved the strength and flexibility of the competitive female basketball players tested and biomechanical properties associated with anterior cruciate ligament injury as compared with pretraining parameters and with posttraining parameters in the control group.</P> <P><B>Clinical Relevance:</B> This injury prevention program could potentially modify the flexibility, strength, and biomechanical properties associated with ACL injury and lower the athlete’s risk for injury.</P>

여자 선수들의 전방십자인대 부상원인과 위험요인

한기훈,임비오 대한운동사협회 2009 아시아 운동학 학술지 Vol.11 No.3

[INTRODUCTION] Anterior cruciate ligament(ACL) injuries occur during sports such as soccer, basketball and handball in which cutting or landing maneuvers are frequently performed. These injuries are more common in female athletes. The purpose of this study were to investigate the mechanism and risk factors of ACL injuries in female athletes. [RESULT] Several theories have been proposed to explain the mechanism underlying the gender difference in ACL injury rates. These theories include the intrinsic variables of anatomical, hormonal, neuromuscular, and biomechanical differences between genders and extrinsic variables(physical and visual perturbations, bracing, and shoe-surface interaction). 70% of ACL injuries were non-contact and 30% were contact injuries. [CONCLUSION] Identification of both extrinsic and intrinsic risk factors associated with the ACL injury mechanism may help with the development of preventive training programs aimed at reducing ACL injury. [서론] 본 연구의 목적은 축구, 농구, 핸드볼 등과 같은 스포츠종목에서 남자선수들에 비해 전방십자인대 부상이 많은 여자 선수들의 부상원인과 위험요인을 규명하는 것이다. [결과] 전방십자인대 부상원인은 여러 가지인데, 외재적 원인과 내재적 원인으로 나뉜다. 외재적 원인으로는 신체 및 시각적 불안, 무릎보호대, 신발과 바닥표면과의 관계이며, 내재적 원인으로는 해부학, 호르몬, 근신경 및 생체역학적 차이이다. 스포츠 활동 중에 발생되는 전방십자인대 부상의 70%는 점프 후 착지할 때 발생되는 비접촉성 부상이다. 부상원인으로는 방향전환을 하기 전의 급격한 감속, 점프 후 잘못된 착지, 방향 조절 실패 등이다. 여자선수들의 근골격계 변화는 관절을 이완시키고 안정성을 감소시켜서 부상 위험을 증가시킨다. 따라서 이러한 요인을 전방십자인대 부상 예방 프로그램에서 고려해야 한다. [결론] 결론적으로 전방십자인대 부상과 관련된 외재적 위험요인과 내재적 위험 요인을 정확히 아는 것은 전방십자인대 부상의 예방과 치료를 위해 필수적이다.

전방십자인대 및 내측부인대 동반손상 환자에서 전방십자인대의 조기 재건군과 지연 재건군의 결과 비교

이동철 ( Dong Chul Lee ),손욱진 ( Oog Jin Shon ),곽해준 ( Hae Jun Kwak ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.1

목적: 슬관절의 전방십자인대와 내측측부인대의 동반손상이 있는 환자에서 전방십자인대의 조기 재건술과 지연 재건술 간의 결과를 비교하고자 하였다. 대상 및 방법: 2001년 2월부터 2007년 1월까지 전방십자인대와 내측측부인대 동반손상이 있는 환자 중전방십자인대 재건술을 시행받고 최소 1년 6개월 이상 추시가 가능하였던 55예(55명)를 대상으로 하여이를 3주 이내에 전방십자인대 재건술을 시행한 조기 재건군과 3주 이후 재건술을 시행한 지연 재건군으로 나눠 Tegner 활동도 점수와 Lysholm 슬관절 점수, 관절 운동을 시작한 후 관절 운동이 90˚가 되기까지의 기간, Lachman test 결과와 전방 전위 긴장 방사선 검사, 외반 긴장 방사선 검사, 그리고 International Knee Documentation Committee (IKDC) 주관적 만족도를 비교하였다. 결과: 최종 추시 시 Tegner활동도 점수는 조기 재건군의 경우 7.4점, 지연 재건군은 7.6점이었으며, Lysholm 슬관절 점수는 조기 재건군의 경우 90.5점, 지연 재건군은 91.3점으로 나타났다(p=0.24, p=0.31). IKDC주관적 만족도는 전례에서 거의 정상 상태로 회복되었다. 관절 운동 회복 기간은 조기 재건군에서, 특히 여성에서 더 오래 걸렸으나, 최종 추시시의 관절운동범위는 양군 간의 차이는 없었으며, Lachman test와 전방 및 외반 긴장 방사선 검사 또한 양군 간의 유의한 차이는 없었다. 결론: 본 연구에서는 전방십자인대의 조기 및 지연 재건군 모두에서 만족할 만한 임상적, 방사선학적 결과를 얻었다. 이는 조기 재건술도 전방십자인대와 내측측부인대 동반손상의 좋은 치료 방법으로 선택될 수 있을 것으로 생각된다. Purpose: The aim of this study was to compare the results between early and delayed reconstruction of the anterior cruciate ligament (ACL) in patients with combined medial collateral ligament (MCL) injuries. Materials and Methods: From February 2001 to January 2007, fifty-five patients who had undergone ACL reconstruction for combined ACL and MCL injuries and who were followed for more than 18 months were included in this study. The Tegner Activity Score, the Lysholm Knee Scoring Scale, the interval to recover 90˚ of motion, the Lachman test, the anterior and valgus laxity noted on stress radiograph, and the International Knee Documentation Committee (IKDC, 1993) documentation were recorded and compared between the early reconstruction group, which underwent ACL reconstruction within 3 weeks, and the delayed reconstruction group, which underwent ACL reconstruction after 3 weeks. Results: At the final follow up, the Tegner score was 7.4 in the early reconstruction group and 7.6 in the delayed reconstruction group. The Lysholom score was 90.5 and 91.3, respectively (p>0.05). All the cases were rated near normal or normal on the IKDC subjective assessment. The early reconstruction group needed a longer time to recover motion and especially in the female patients. However, there was no statistical difference between the groups for the final range of motion, in addition to the Lachman test and the anterior or valgus laxity. Conclusion: In this study, satisfactory clinical and radiological results were obtained in both the early and delayed reconstruction groups. The early reconstruction of the ACL seems to be one of the surgical options for reconstruction of acute ACL injury combined with torn MCL.

The Effect of Frame Rates on Knee Kinetics during Landing and Cutting

이승훈,신충수 한국정밀공학회 2013 International Journal of Precision Engineering and Vol.14 No.2

The analysis of knee kinematics and kinematics during high-risk movements associated with anterior cruciate ligament (ACL)injury is essential to studying the mechanism of ACL injury. Motion capture at low frame rates may not always detect the actual peak values during high-speed movements. However, the knee kinetic differences between various frame rate measurements during high-risk movements have not been reported. The purpose of this study was to investigate whether 3D knee kinetics would be measured differently between frame rates such as a high frame rate (1200 Hz), 400 Hz, 240 Hz and the popular low frame rate (120 Hz). Knee kinetics during a single-leg drop landing and side-step cutting under different frame rates were repeatedly measured and statistically compared. Peak knee valgus and tibial internal rotation moments measured at a popular low frame rate were significantly lower than those measured at the other frame rates of 400 Hz and 1200 Hz. The peak anterior and superior forces measured at the highest (1200 Hz) frame rate were significantly higher than those measured at any other frame rates. In addition, the variations in the peak kinetic values were significantly larger at the lowest frame rate capture and trended toward being smaller at the higher frame rates. In conclusion, significant differences in the knee kinetics between the frame rates suggest that the high frequency capturing increases the accuracy of the knee kinetics measurement for high risk maneuvers for the study of ACL injury.

Methods to determine the volume of infrapatellar fat pad as an indicator of anterior cruciate ligament tear

Cheruvu, B.,Tsatalis, J.,Laughlin, R.,Goswami, T. Techno-Press 2016 Biomaterials and Biomechanics in Bioengineering Vol.3 No.1

Anterior knee pain is a major problem among adolescents and young adults especially those who participates in sports. The most common pathogenesis of anterior knee pain can arise from compression and shear forces in the patellofemoral joint. It is also caused by impingement of infrapatellar fat pad. Fat pad impingement can occur when the fat pad becomes swollen and inflamed due to a direct blow or chronic irritation. As a result, the bottom tip (or inferior pole) of the patella can pinch the fat pad. One of the many causes of swollen fat pad can be secondary to anterior cruciate ligament (ACL) injury. The aim of this study was to compare the infrapatellar fat pad volume in patients with acute ACL injury and a group of age-, gender-, and activity- matched controls with intact ligament. Axial magnetic resonance (MR) images have been performed on 32 patients with torn ACL and 40 control patients. The volume of the fat pad was measured digitally from MR image by using a 3d Reconstruction software, ellipsoidal approximation, and a MATLAB code. The results were compared between patients with torn ACL and control group. Patients with a torn ACL had a significantly larger fat pad than the controls (P=0.01). There was no significant difference between the methods used to measure the infrapatellar fat pad volume (P=0.83-0.87). Thus, lesions of the infrapatellar fat pad is often associated with ACL injury.

Methods to determine the volume of infrapatellar fat pad as an indicator of anterior cruciate ligament tear

Cheruvu, B.,Tsatalis, J.,Laughlin, R.,Goswami, T. Techno-Press 2016 Biomaterials and biomedical engineering Vol.3 No.1

Anterior knee pain is a major problem among adolescents and young adults especially those who participates in sports. The most common pathogenesis of anterior knee pain can arise from compression and shear forces in the patellofemoral joint. It is also caused by impingement of infrapatellar fat pad. Fat pad impingement can occur when the fat pad becomes swollen and inflamed due to a direct blow or chronic irritation. As a result, the bottom tip (or inferior pole) of the patella can pinch the fat pad. One of the many causes of swollen fat pad can be secondary to anterior cruciate ligament (ACL) injury. The aim of this study was to compare the infrapatellar fat pad volume in patients with acute ACL injury and a group of age-, gender-, and activity- matched controls with intact ligament. Axial magnetic resonance (MR) images have been performed on 32 patients with torn ACL and 40 control patients. The volume of the fat pad was measured digitally from MR image by using a 3d Reconstruction software, ellipsoidal approximation, and a MATLAB code. The results were compared between patients with torn ACL and control group. Patients with a torn ACL had a significantly larger fat pad than the controls (P=0.01). There was no significant difference between the methods used to measure the infrapatellar fat pad volume (P=0.83-0.87). Thus, lesions of the infrapatellar fat pad is often associated with ACL injury.

Exercise Rehabilitation after Anterior Cruciate Ligament Reconstruction

Keun Ok An(Keun Ok An) 사피엔시아 2017 Exercise Medicine Vol.1 No.-

OBJECTIVES: Exercise rehabilitation after anterior cruciate ligament (ACL) reconstruction has changed dramatically in recent years. In this review, we discuss recent changes in exercise programs related to ACL rehabilitation. METHODS: We conducted a literature review of recently published articles related exercise programs after ACL reconstruction. RESULTS: The accelerated rehabilitation program, which allows patients to achieve full extension of the knee early in the postoperative period, is now a widely practiced rehabilitation program. A prospective study of rehabilitation programs after ACL reconstruction showed that early joint exercises do not interfere with the healing of grafts. Instead, they alleviate pain, thereby reducing the negative impact. Moreover, according to several biomechanical studies, open kinetic chain exercises are potentially disadvantageous to knee stability. There is no evidence that early weight bearing results in weakening of graft distraction or internal fixation compared with delayed weight bearing. CONCLUSIONS: In conclusion, prevention of ACL injuries and rehabilitative exercise training can help to achieve optimal exercise performance while avoiding the risk of sports-related injury.