前十字韌帶損傷對下肢運動生物力學的影響

Biomechanical Analysis of the Lower Extremity for the Anterior Cruciate Ligament Injury

10.6162/SRR.2011.112.10

張世緯(Shih-Wei Chang)；張怡雯(Yi-Wen Chang)

運動傷害 ； 前十字韌帶重建手術 ； 膝關節 ； sports injury ； anterior cruciate ligament reconstruction ； knee joint

大專體育

112期（2011 / 02 / 01）

69 - 75

繁體中文

前十字韌帶損傷是一種相當普遍的運動傷害，大多數患者的受傷過程並非外在接觸性撞擊的影響，而是由於人體下肢在減速動作時，突然改變方向或是跳躍後落地動作不正常，造成前十字韌帶的負荷過大，導致非接觸性傷害的發生。前十字韌帶損傷後，在步態中可以發現有股四頭肌抑制(quadriceps avoidance)現象；在跑步方面，雖然沒有明顯股四頭肌抑制現象，但在著地期時，膝關節出現屈曲角度減少，與內側位移增加，顯示損傷後的膝關節呈現不穩定狀態。若接受前十字韌帶重建手術，在術後初期的步態中，依然會出現股四頭肌抑制現象，在術後4個月的步態已趨近於一般健康正常人的模式，然而，在脛骨旋轉動作卻仍然無法恢復至正常範圍，顯示經過前十字韌帶重建後，也無法完全恢復至受傷前的動作模式。未來研究方面，可以進一步探討穿戴護具或使用運動貼紮方法，能否有效地改善前十字韌帶損傷患者的生物力學表現。

Anterior cruciate ligament (ACL) injury is one of the most common sports injuries. The injury mechanism for most victims is the non-contact injury, resulting from the overload on the ACL due to the sudden change of moving direction in decelerating the lower extremity, or improper landing. Quadriceps avoidance is obvious in gait after ACL injury. The decreased knee flexion angle and the increased medial displacement in knee are found in the runners after ACL injury. Quadriceps avoidance in gait is still evident immediately after ACL reconstruction. However, gait pattern is reaching normal after the reconstruction of four-month, but tibial rotation is still obvious in gait. It is implied that it is difficult to regain the non-injured motion pattern even accepting ACL reconstruction. In the future studies, the effect of athletic taping or brace will be conducted to more understand the biomechanics of ACL injury so as to improve the athletic performance.

1. Alexix, O.,Sharon, O.,Charles, L. L.,Elaine, T. J.,Kwon, Y. H.,Bruce, E.(2008).Landing mechanics between noninjured women and women with anterior cruciate ligament reconstruction during 2 jump tasks.The American Journal of Sports Medicine,36(1),149-157.
2. Beard, D. J.,Murray, D. W.,Gill, H. S.,Price, A. J.,Rees, J. L.,Alfaro-Adrian, J.(2001).Reconstruction does not reduce tibial translation in the cruciate-deficient knee an in vivo study.The Journal of Bone and Joint Surgery,83,1098-1103.
3. Boden, B. P.,Dean, G. S.,Feagin, J. A., Jr.,Garrett, W. E., Jr.(2000).Mechanisms of anterior cruciate ligament injury.Orthopedics,23,573-578.
4. Chappell, J. D.,Creighton, R. A.,Giuliani, C.,Yu, B.,Garrett, W. E.(2007).Kinematics and electromyography of landing preparation in vertical stop-jump: Risks for noncontact anterior cruciate ligament injury.The American Journal of Sports Medicine,35,235-241.
5. DeMorat, G.,Weinhold, P.,Blackburn, T.,Chudik, S.,Garrett, W.(2004).Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury.The American Journal of Sports Medicine,32,477-483.
6. Flynn, R. K.,Pedersen, C. L.,Birmingham, T. B.,Kirkley, A.,Jackowski, D.,Fowler, P. J.(2005).The familial predisposition toward tearing the anterior cruciate ligament: A case control study.The American Journal of Sports Medicine,33(1),23-28.
7. Gelber, A. C.,Hochberg, M. C.,Mead, L. A.,Wang, N. Y.,Wigley, F. M.,Klag, M. J.(2000).Joint injury in young adults and risk for subsequent knee and hip osteoarthritis.Annalss of Internal Medicine,133,321-328.
8. Gottlob, C. A.,Baker, C. L. J.,Pellissier, J. M.,Colvin, L.(1999).Cost effectiveness of anterior cruciate ligament reconstruction in young adults.Clinical Orthopaedics and Related Research,367,272-282.
9. Griffin, L. Y.,Albohm, M. J.,Arendt, E. A.,Bahr, R.,Beynnon, B. D.,Demaio, M.(2006).Understanding and preventing noncontact anterior cruciate ligament injuries: A review of the Hunt Valley II meeting, January 2005.The American Journal of Sports Medicine,34,1512-1532.
10. Knoll, Z.,Kocsis, L.,Kiss, R. M.(2004).Gait patterns before and after anterior cruciate ligament reconstruction.Knee Surgery, Sports Traumatology, Arthroscopy,12(1),7-14.
11. Petschnig, R.,Baron, R.,Albrecht, M.(1998).The relationship between isokinetic quadriceps strength test and hop tests for distance and one-legged vertical jump test following anterior cruciate ligament reconstruction.The Journal of Orthopaedic and Sports Physical Therapy,28(1),23-31.
12. Prodromos, C. C.,Han, Y.,Rogowski, J.,Joyce, B.,Shi, K.(2007).A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen..Arthroscopy: The Journal of Arthroscopic & Related Surgery,23,1320-1325+e1326.
13. Ristanis, S.,Stergiou, N.,Patras, K.,Tsepis, E.,Moraiti, C.,Georgoulis, A. D.(2006).Follow-Followup evaluation 2 years after ACL reconstruction with bone-patellar tendon-bone graft shows that excessive tibial rotation persists.Clinical Journal of Sport Medicine,16(2),111-116.
14. Shelburne, K. B.,Pandy, M. G.,Torry, M. R.(2004).Comparison of shear forces and ligament loading in the healthy and ACL-deficient knee during gait.Journal of Biomechanics,37,313-319.
15. Shelburne, K. B.,Torry, M. R.,Pandy, M. G.(2005).Effect of muscle compensation on knee instability during ACL-deficient gait.Medicine & Science in Sports & Exercise,37,642-648.
16. Tashman, S.,Collon, D.,Anderson, K.,Kolowich, P.,Anderst, W.(2004).Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction.The American Journal of Sports Medicine,32,975-983.
17. Uhorchak, J. M.,Scoville, C. R.,Williams, G. N.,Arciero, R. A.,St. Pierre, P.,Taylor, D. C.(2003).Risk factors associated with noncontact injury of the anterior cruciate ligament: A prospective four-year evaluation of 859 West Point cadets.The American Journal of Sports Medicine,31,831-842.
18. Waite, J. C.,Beard, D. J.,Dodd, C. A.,Murray, D. W.,Gill, H. S.(2005).In vivo kinematics of the ACL-deficient limb during running and cutting.Knee Surgery, Sports Traumatology, Arthroscopy,13,377-384.
19. Yu, B.,Garrett, W. E.(2007).Mechanisms of non-noncontact ACL injuries.British Journal of Sports Medicine,41(Suppl. 1),i47-51.
20. Yu, B.,Lin, C. F.,Garrett, W. E.(2006).Lower extremity biomechanics during the landing of a stop-jump task.Clinical Biomechanics,21,297-305.
21. 康翠籃(1998)。前十字韌帶重整手術後的復健。大專體育，35，127-133。
22. 張曉昀、黃啓煌、蔚順華、鐘宇政(2008)。比較前十字韌帶重建手術運動員在不同動作下之膝關節運動學。物理治療，33(1)，24-33。

1. 胡林煥、李建毅、吳忠政、余清芳(2011)。排球運動選手之前十字韌帶傷害探討。交大體育學刊，2，98-106。
2. 黃長福、張博涵、杜之譽(2017)。股四頭肌肌內效貼紮對下肢疲勞之影響：以生物力學觀點。運動表現期刊，4(2)，111-117。
3. 黃長福、張博涵、洪敏豪(2014)。急停跳動作之傷害機轉與預防－以生物力學觀點進行探討。運動表現期刊，1(1)，25-28。
4. 林嘉芬,何承訓,王順正(2019)。動態貼布貼紮對女子排球員下肢肌力之影響。運動生理暨體能學報，29，1-8。
5. 張博涵、翁梓林、林羿君(2013)。不同膝關節貼紮類型對急停動作穩定性之影響。大專體育學刊，15(3)，374-382。