Background:The understanding of noncontact anterior cruciate ligament (ACL) injury causation in soccer has improved over the past decades. Bidimensional video analyses have significantly augmented our awareness, representing to date the only practical method to describe injury biomechanics. However, the extent of the problem continues to raise serious concerns.Purpose:To advance our understanding of the causal pathways leading to ACL injury with a large-scale reconstruction of 3-dimensional (3D) whole-body joint kinematics of injuries that occurred to male elite soccer players, as well as to compare the joint angle time course among situational patterns.Study Design:Descriptive laboratory study.Methods:A total of 33 consecutive noncontact and indirect contact ACL injuries that occurred in 6 national and 2 international professional leagues (seasons 2020-2021 to 2022-2023 until December 2022) were analyzed: (1) multiview noncoaxial television images were inspected; (2) multiple camera views were taken from 400 ms before the initial ground contact to 200 ms after the injury frame; (3) a size-matched pitch was modeled and used to calibrate cameras; (4) a 3D skeletal model was adjusted to fit the player's pose in each frame/view; and (5) poses were interpolated, and Euler joint angles were extracted.Results:The authors reconstructed the 3D lower limb joint kinematic curves preceding and during ACL injuries in 33 cases; notably, a sudden external (up to 5°) and then internal knee rotation was observed after the initial contact and before the injury frame. The overall kinematics at injury were knee moderately flexed (45.9°± 21.7°), abducted (4.3°± 5.1°), and externally rotated (3.0°± 6.4°); trunk shallowly flexed (17.4°± 12.5°) and rotated and tilted toward the injured side; and hip flexed (32.0°± 18.7°), abducted (31.1°± 12.0°), and slightly internally rotated (6.6°± 12.2°). Variable behaviors were observed at the ankle level.Conclusion:Via reconstruction of the sequence of whole-body joint motion leading to injury, we confirmed the accepted gross biomechanics (dynamic valgus trend). This study significantly enriches the current knowledge on multiplanar kinematic features (transverse and coronal plane rotations). Furthermore, it was shown that ACL injuries in male professional soccer players manifest through distinct biomechanical footprints related to the concurrent game situation.Clinical Relevance:Interventions aimed at reducing ACL injuries in soccer should consider that environmental features (ie, situational patterns) affect injury mechanics.

中文翻译：

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男性职业足球运动员非接触性前十字韧带损伤的三维生物力学

背景：过去几十年来，人们对足球运动中非接触性前十字韧带 (ACL) 损伤原因的认识有所提高。二维视频分析显着增强了我们的意识，是迄今为止描述损伤生物力学的唯一实用方法。然而，问题的严重程度仍然引起人们的严重关注。 目的：通过大规模重建 3 维 (3D) 全身关节运动学损伤，加深我们对导致 ACL 损伤的因果路径的理解。研究设计：描述性实验室研究。方法：在 6 个国家和 2 个国际职业联赛中发生的总共 33 例连续非接触性和间接接触性 ACL 损伤（分析了2020-2021年至2022-2023年直至2022年12月的季节）：（1）检查多视图非同轴电视图像； (2) 从初次触地前 400 毫秒到受伤帧后 200 毫秒拍摄多个摄像机视图； (3) 对尺寸匹配的节距进行建模并用于校准相机； (4) 调整 3D 骨骼模型以适合每个帧/视图中玩家的姿势； (5)对姿势进行插值，提取欧拉关节角。结果：作者重建了33例ACL损伤前和损伤过程中的3D下肢关节运动曲线；值得注意的是，在最初接触之后和受伤框架之前观察到膝关节突然外旋（最多 5°）然后内旋。受伤时的整体运动学为膝关节适度屈曲（45.9°±21.7°）、外展（4.3°±5.1°）和外旋（3.0°±6.4°）；躯干浅屈（17.4°±12.5°）并旋转并向伤侧倾斜；髋部屈曲（32.0°±18.7°）、外展（31.1°±12.0°）和轻微内旋（6.6°±12.2°）。在踝关节水平观察到不同的行为。结论：通过重建导致损伤的全身关节运动序列，我们证实了公认的总体生物力学（动态外翻趋势）。这项研究极大地丰富了当前关于多平面运动学特征（横向和冠状平面旋转）的知识。此外，研究表明，男性职业足球运动员的 ACL 损伤通过与同时比赛情况相关的不同生物力学足迹表现出来。 临床相关性：旨在减少足球中 ACL 损伤的干预措施应考虑环境特征（即情景模式）影响损伤力学。