A\Jlhoriz«l, ReprJl1it frnm 'Stllllll.tl:l"Q' T~hn1Cll1 ~'lolblr,.

:~Ugn ~02~,

COpyf"~l'It "lM:rlan SKl4i,l)' fOr T,estln'l! !!po;! ,~I"'rl.l1i '~6IR(cl!' St,rHt. Pl'ill!!d~l'phl •• P", "!HD3 llno

REFER:ENi;OE.: !;iguer.<\>s, J .. M., Vidal" A .. , Esca las , F., MerIno, 1.. A.;, Es-pad~,I~r~<ja:n')i:;an'S, J, M .• an:ti <='~t,a'll:y:et} F., "'More.oJ!! tn~;, Winns 0:1 the! Ant.erio:t Croc~le Li~m~nt and Th:eit P,reventio.1':n)!fki~rSl~~' [8 S:k.itn.gT1'~iUm,~ dnd $i:ffe(~': $'ev'e'l'lOi 11liemaliQ~al S:;i?1}J(Jshml. ASTM STP UJ22, ROIhert LJo.hn:m:n, 'C. n. Mme, fr., and Ma:ru-He:rv~e lliudi E~s., Am'erican Suciety fg,r Testing a~ Mntefi_als~ Pbilaeefpili -, at 1(}8:9:._ pip. J fl.-lIS.

. - ."." .

ABS'iRAeT,;.. Too,authors fU'ith~r tbe:1], wswrdl 'studies presented at the Intel'J1i*io~I.8QdelY iG,r Skiiing S.afcly (rS$:&, ~-eystflp.e; and Nil1bll' t':png~~es Oil' the i-S0la{ed ,i¥tJ;te:y.~@te:i'ttci<'lt15 liga1'!lent lesiO-li:sa~d"Ilt:1£e;;j,sS.o~la.l~~with .m~micP's;~iRj.lltfe!!, UtWHgh a:rtll'ltoseol1ic c@l1H.Ql. T;l'l1~ s,l'udy C61'1- i';kk.n' HH~ mell:b,;1I-n·j "fms ~'l £ pl:'odtwli@t1t.o-f rlle_II1Ju:6es and til e sh;')t;:s:lIe$ to 'lib kit, the knee is su om itted ilil !i:om,ec~e:f in alpiAe,~!cliif'lg, sitllCe dre -llfnteri~ eruciate IiigameR'I: rupture ean ooearwitboat the skier fa1Iing~PUS:lii,ibje_ rilC31'lS ro preYelii thcse:~nCrea5i"llgly 'C(1)'tIlni.Oll alpine skiing j~jt_lr.ies are also searehed {G-r in tb~s papeF.

KEY 'YQ'RDS,= ~'.'l1t,el"im' C:i"u:cjat~ ]igame-l:1t i:ri~jnrics.~1k iing accidents, athletic i1i1jurie~, knees [biD-' nlc'chaniis.)" -sk.i,~o-ots

]11 N«e-~. we"s:g_o;k'e- ab'O'ul the ~SJ)""lrtjMl Jesion vi the allt'ednr eruclat~ Iiga-m,ent {A·tL)il"l skiers. s,(n~' liilen, -0']:1:1" pl!e,j)'ccnpatiOli~IJ)1lQ.ern-i-ng this Iigarneat has increased beG{l:l1s-e, as we aJ:~ know' ihi's,'£esipn is, beecming more frequent Of moee.frequeatly diagno.s@d.

MlI~ria~s ;~rld Meth~ds,

f'I'Gtn 1'9&4 to 19:87 we' gath'ere'd,Q~ eases' of .skiers wltl! ~l} ACL I_esion ,~ud with no Qthel' lig~le~fuus:_intuItY in the knee, AU B-.:?s@s were diagnosed thrQI~_gl:r,arUU"(H~J;O~~Y.

We stiu,die1li the existeJl'ce' of a.ssoC'~a'te-d me:ni'Sc'Nciii: Iccsions, 'We (Hvi~ei!l the P'll!hHe:f:lts iiruto two groupl';;':' those who sustainedrecent lesions of the ACL and t'&OS€ -slIffebug h'011n old lesions, We locked at tile ,slbc, age, injured si de, teehnleal Ieve], and meehantsm of the 'fa 11.

W..e'-havt:;, K--.rayed' one S'kier-'s leg, with his sId 00 and his; kne'e. beJ~bd a 90Gl- angl'!': bf'Mt'!,ans,of te:Jel'ra'di~.fQgy w.th two 3Q- by 9U-cm 'cassettes Fig. 1).

Ft'fji;rnfheteletq:diQlagical measuremeaes, we have,c'aku~ated the stresses to WWdl sQm-elbnee structures are submitted;,. With a dynamometer we measu;r-erd ~h~ stress applied onth:~ posteriersnpeFtOr part of the hoot, when the skier v;,as in a backwards 'p1()Sitioo. by means of a plece of

I,Cha1'l'mun a~L(! stan: '!,bys-ici:aru, respeetively, D~p<il1m:eflt £If' Oli:ffilOp'aedie Surgery and Department of Research and PrevtfiltOn o.f S,ld AccldeDt5~, H05.-pitaJ de 13 Crel!l Raja:, nos, de Mairg JOI. osms BaitGell)'iltl, Spain.

lCh,aitm:an 9epartm;etl,~ of Erect"r'.om.N&mpRr. Hosll~taI del Mar, OSOOJ 8a£ctdon:a:, Spain;

JEliI'glneer ETS,El. B-are.e~oJl.a ;s,~aiH. -

112

doth il1atet~al H) ~m 'w1depfa:eed 'a.rl1iltl.tl Jt)-e ·calf. 'Mt:anwbile" ~~gkier had bi£.lJ6ot OJ) 'theiSli;i

with the I:)Oilt ll1nbuc,\<Jed (Fig.. 2). "

We ilna,ly'lfet13N:-r'8i9s ni th~e p'fQ£i,110 of a skier's nor-mal] knee, beth wheQ' ~~J'vesit1r,j::r;S:5' wa_s a~ ... plied in the_sit.-'back .PQ!ii,Hiofl !il!nd w~e;n nesttess was app~ied.

Throughl.X~:raysj w\Jllookfilo·at.tht pf'olUe pf a knee wi.th ua;,A:U CP-ig. 3) in three cenditiens: without stress; with the ma",imum,ac.tive stress with the boot and. ski:oo; and ,with.!p,a;ssi~e·,.s;ti:'e~~, byplaci'ilg the: $kier i11a prone p:C}sitilO];l.fJe:dng tb'e knee ;to 9a~;, ilnd p,itOi\lucingan :~/Bt~rtol dl:'Clwer. dA~pla~e'fl:leot w~tb .~ lQ'i:ec'$ Ql -~Ioth 11lat~fb:1 eonnectedtc a dy~~moWfil}tet W'h~n a.pp~j;ti'ig;, ' the &a.m~;fbrce that we had ,me3..s-Ured· with the ,ma-xhoo,um :<J~iVe .·~tr~~s. (Pi,g. 4). _

W'f:. 'e'leetT:omyogtaphic3.Jly ~.XaUline~ the·.quadtieep~ .ana th~ hamstJtmg.~ acth',itjf w::biia ,th~

ki " " t . ' 'I!... 1_ d ..

s wr W£I,s' Ul a m.alX.tm:llm uaCli.w.ar', spositioa.

,

o.rthe 55·,~ase~,itlt'his si~ti~'$ of':ACL ruptures', 19 ca,c'$esw~ te:oon'tJlt!sid1t$:. ~'44%'-of~h6:;. 2-9

c.~~e:s~:) th~ le$iOfls-were a$:B(.reia1~d w-llt~ a. m~nf~~.u s irijuyyjl'8-,~:o/ilc ··~wiieli 'W~fI.e 1l,~d~~~ I 54~i

w:eti1:i l~ru~.1j_ ,alto 1 ~a'$@ wa~·~bUaml'::~J ,m;eni~:Qus 1:fij~.rY.' '

Tweltty-six c-ag~s, .. itllVo:hred kliJe:~s;th:at ta;:ve 'Wi~'f:tepeatediY'ar,wel'e ~relt- tlJ' have the put, 'rHinll0'

s;ive ~'a'YQY the-p:a:~;jewr-~JJut 'fll :all ~tlhe:m ,there'wafS a history or 0.:11 old J hIli In 'I 1~,t'fltlll\C knot: ,(1M

. a, re.'lult Qf a~11 loi:ttal,sk:i'tng: inj ury. Of these C~cS!JS '8'1 (~I Imil un a s~I)Q1H tur'1 Ol! 11 ,M II'~ ) 'H II IoU I 14 I~ I whitih we"l"e Llls'dlul {~fl.$ fJln). 4 w, '1'C hll r,1'!l1 t H) \yj,), II ~~d ; , blhll !',~ 11

1 '14 SKIING TRAUMA, AND SAFETY: 7TH INTERNATIONAL SYMPOSIUM

F1,G. 2,-MeaS"ul'e' q:/lheactive ~ti'eS,S wppliedM the le.g al the level af the pes,tel'io-sv,pt!:rlnp, p'tJ'I':I' oj 11m bi1fi,t.

I

f1 . l-X·rays profiles f)/:o knee with 1H') ;ACL ill tnr'Oe cl.mditi'(miJ,' (left) witlwut $tre~g." (midd1:e) ""iiil Qc~'i'll > I,UteS I I'm 1 ( .. i,I 1t ), wit,1I P(Uli'fl .$tI,~ .:1.

FIG. 4'~tl.'t.uli.olQ,gi~Q,1 (;!xam while' a.PPW'~~ Q .p~ssiV"e stress-tse« Jiig. 1jor p'4~si~e. 'stress],

. .

In th.e acutecases t' wI$: only have intormaticn Of the m$eto:scopJc U:~ien.dn 21 cases.. 14 -of which were within the ligament body afJd '7 \-rere,£eml.\lit,al avtl1~i0n~.

In the c;';IIse:-s.{)f ~ld 'iujuries, we have inftifnra,til)na,botlt lffaaS"fl!;, that macroscopieallyshowed

• t _." .

an absent ligament; shrededremnants, or. somfl~mand'ist:al stump.

The injuf·ies a .. ppeared in 27 men (49.1 %) and in 2,$ women (50.9%)~ (Ac:cmrdhlgto our general sta-tistic's, b3ulo of the total injured skiers were men and 37% were women.) The age average was, :28' .yoo;ts,·, ~werrty cases involved tlui( tight r!ig -~nf! ttHrtY~{hrE:;·fh.;el eit,.

Con~l1in,g; fbe, m.~cbaHtsm ()f' fall,. as we. h~d ~t~ted ijJ qur pap~r in N~b~, fhis ·inj·ilJ.1fY is ffe~Il~J).Uy p£Q"d:u~d: llS, a.1"~lllt ~f a 'b~c.k~jl-rds, taU Ill], In 14 ·C1~'S~s·tbe in}14rJ(w~s l~tod uced in an

attempfto re'~gv.tr t:r.o,m·'llob,ac'k\var:d~ pOiSlfi:e:n wit'houVtoo skier laUing. I .

In tbe~e, ~.'a:~l.·'Q~:lseE .• tbe,:s,kie~.s:.·~echnt¢aI ~km 1:e~\eJ was 'high. InJm'~~G of all CRies tlte-,sklers skin

level W'3.S 80cr,d.· .

T('!leradie'il~aphy,anQwed t1stooi)tt:m tlle;'mtlJt8ut:etneilts fj#c·eSi\'l,t=j.ry to. fltrd gut thestresses to which the ,,!dgt::s,uhhlits"l11S kne~' ~$~uclures·dep·ending en the ~i:tJliltkm .ofth~ eetJ.ler!ijf gravity of weight 'of-the body' pa1!I. th~l. gl\ilvit~ 't:$:Q;n tHe tibt'aJ p I a.te~u tV in reJa1.ion to .th€ knee "(Flg. 5,).

Tll;e faith,r TendOfiFolrce e"tiua!S:'

(see,l~·ig, S'f,®'r D c.m and.S €ludfdi.IDli-ii0t'l5J':

- • -.~ I •

The'c.OllJp:t1fe'Ss·&o.n on the t~bial p .. late-au .eqlli~ls:.

,

The'~tr:eS:8 within the ACLJhti:mCDt and wtthin tb(Htrl.1J~t8tes \h.·art preiv~tJ'.b.~ antertoe drawer ~n ~e COJ);$-id@fedneftdy¢qu_~.tand 'il'pposit;e tQ the etm11~~e3frj:"e fQl''')e Bf the_V'iltela ~a!tahlst tm.e -[enl.ut~ which is the resultal)t ~()f'ce'~f the paselar tend.o;a anlthe qliaddceps f6rc~, (Fig. 6). 1'1'1& pa~:sLbi fity. af v-alu icng the sb-e·5s-9iRpheG adh'tily" lUl th:~ ·L'lollt.erior p.!$I't of th c'leg 1 y a ': Jtl1 ~n -a backwatds position gives us the opportllnil,t,y te det J:Jl']ill ttt I re S . appll d on h rd - uctures dud ptievent the intetier drawer.

11® SKIING TRAUMA.AND SAFFTV': 7TH INTERNA,TIONAl SYMPOSIIUM

FI G. 5-So'~e1#eQ b;,t~H:h'edjr@,m: tJ teLe."'fl:~i9Q nip h~~ );d>ie<r~ .' he !i,t"e.s~ of 1:11 Ii' pate1 ar te1:ld~rl ami rlut1(>:I1tQ:rt;~ i compr'e.'ssion ,on. l:lLf! tihf:aJ plateo,.lJ. CJ1'€ SMQV,m. j cm= diSfgnce. measured Qfl--lhetele.r~4iQg,mphJ'.l>e.l;wmm the tibial insertion' of .the pateltlf tendon and the eppttcaelon point Q of the J€m~lr on thetibia. W = weigbt f.1:.f the' bod)! part lhiJJ gruvltate:s 011 the tib.ial plateau. DCN! = diStance. between r/~e center of gravity of the

body pari W GJ.til,tJie.p,Qin't Q, £:t= 90°. .

J II

\

FIG. ,~-Sc1it:m~.dUJ'fVi,,~ t~'€ff)r¢e"Q:p,plt~d ()i!,~t!ej'ttt~fi,r {-t~Ugh, tli-e' p4t'f,iaI Whiqh i~,tFg~,ft~1ri1f 11 ~J~e .f/!m.,· _$' I llll.eQlUrdricep~ ijml, ~hf. ptltela.;: t:fffndOn. tlt,thli,"&U1l.aiitJ1;~·,qJt ~ .P!tIi.i:.ime .th{.sjon; iwilrfJr~dy'¢e ~lte (mil' r'u( d"(J'fIIl'" mal \tIiI1l,~. tHmUtract ,/1 l>;v tn'" drtfp.tattl ~"r'Hl;:tUr·t!S>, 1Mtl$ClUar rh-amstrl7tg.fi) flnd lig;IJ:menWjl~ (, rf '/. jjml ,'II tjiHM, 111M ,II ~U" 1'1"/1' mHf pi~ ';;'1'(\' fll~~,~l rll!' (mf"""i(Jt d'-I'II (,(It: Inwrl,r rl r'ii liI;1

FIGUERAS ET AL ON ANTERIOR GRljCIATE LIGAMENT LESJ'ONS, 117

The radiologJ'caJ study of ii, l1:ru1naJ ktlee'a:p'p.Jyifi~.a. llr~ximum' epntpr.~s'S.io~ en the posterior part of the' boi1t doos, 'tlotsbt)¥I ~U~, ~ntet;'ot dn~~~.

Tn'€: L"a,d"iQl,Qgie~l stud-y ,pf -, i;l ktl£~ with. ThQ At;L·~ appl£i.tig a maximum compression on the po~~erio-sup~tior :pap; Qf th~ :qt19tl s.hewed a less prominent drawer than that piQduced by pas-

:s~vely npJlJyingE1:ulr$~m~'.fotre:e (Fig., 7).' ,

The electl'0fIlyograp·hy in D, skier's oIu::kward Pf) 1tiO.o snowed ij 111().re i'ilt~ll$~' contraction at the level 0-£ th:e,qu~<irkeps thtUl at that (lit tl'i'e'hallllsirin'g,lf ~ltho~gk the e('i)illU3;lZti~n of the-latter is evident.

Recent .esia-ns"whi,t·h au' bec01:uitlg mote and more common, were assodat,ed if! 440/0 of'the cases with menisGus Injuries. of the pat.lents with old A.CL leslens . .- 81 ~o hi\l:~-'lil~~ni!;,cal lnjudes. In recent 'lesions the latera-l men~sc:u5, is Inure freq~ently affe~ted." II;l cUI. leslc);i1s the medial

'lDenisf!tts is most ·affected. '

AccQ.t'Qing to our gene-tal st.!\tistics~ QJ% o{ the total injured skiers are mele and 370/0 are female. In the: case m ACL i:njut~es, we find that 49.10/11 are male while 50.9% axe female. Therefore VW;) conclude that: wome;n have a .higher ACL injury rate t]rM men.

A ba"ckwa;r.ds position of the skier with a normal knee does not produce ,R drawe-r. In a knee lackhlg ACL. the passive drawer isgreater than 't1Hil active tli'awet', '~\'e-n if tbe stress applied on the active drawer 15 mQre intense, Th€j' action of the hafilSilillgs pe,rthi:Uy '(Jt®c:ects the degree' of

the ant.erior dfawet. "

FlO. 1-.ff.rid'0il,rtlJJ{ly tif' a km.w 'wMIUUtl ..t.(!,t rtpply,i"'iJ tiN! t~tmlllj'",~,,! ,i"l b"Qa~ sitIiUliu(l, . "(~). tlr« ,1 r

.. ......._ ,_.iII .L. ! ...

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